Division of Orthopedic Trauma Surgery, Department of Orthopedic Surgery, NYU Langone Health, NYU Langone Orthopedic Hospital,New York, New York.
Department of Orthopedic Surgery, Jamaica Hospital Medical Center, Queens, New York.
Pain Med. 2022 Sep 30;23(10):1639-1643. doi: 10.1093/pm/pnac002.
To assess the effectiveness of a multimodal analgesic regimen containing "safer" opioid and non-narcotic pain medications in decreasing opioid prescriptions after surgical fixation in orthopedic trauma.
Retrospective cohort study.
One urban, academic medical center.
Patients with traumatic fracture from 2018 (n=848) and 2019 (n=931).
In 2019, our orthopedic trauma division began a standardized protocol of postoperative pain medications that included 50 mg of tramadol four times daily, 15 mg of meloxicam once daily, 200 mg gabapentin twice daily, and 1 g of acetaminophen every 6 hours as needed. This multimodal regimen was dubbed the "Lopioid" protocol. We compared patients who received this protocol with all patients from the prior year who had followed a standard protocol that included Schedule II narcotics.
Greater mean morphine milligram equivalents were prescribed at discharge from fracture surgery under the standard protocol than under the Lopioid protocol (252.3 vs 150.0; P < 0.001), and there was a difference in the type of opioid medication prescribed (P < 0.001). There was a difference in the number of refills filled for patients discharged with opioids after surgical treatment between the standard and Lopioid cohorts (0.31 vs 0.21; P = 0.002). There were no differences in the types of medication-related complications (P = 0.710) or the need for formal pain management consults (P = 0.199), but patients in the Lopioid cohort had lower pain scores at discharge (2.2 vs 2.7; P = 0.001).
The Lopioid protocol was effective in decreasing the amount of Schedule II narcotics prescribed at discharge and the number of opioid refills after orthopedic surgery for fractures.
评估包含“更安全”阿片类药物和非麻醉性止痛药的多模式镇痛方案在减少骨科创伤手术后阿片类药物处方的有效性。
回顾性队列研究。
一个城市的学术医疗中心。
2018 年（n=848）和 2019 年（n=931）创伤性骨折患者。
2019 年，我们的骨科创伤科开始了一项标准化的术后疼痛药物治疗方案，包括每日四次 50mg 曲马多、每日一次 15mg 美洛昔康、每日两次 200mg 加巴喷丁和按需每 6 小时 1g 对乙酰氨基酚。这种多模式方案被称为“Lopioid”方案。我们将接受该方案的患者与前一年接受包括 II 类阿片类药物的标准方案的所有患者进行了比较。
在标准方案下，骨折手术后出院时开具的平均吗啡毫克当量明显高于 Lopioid 方案（252.3 对 150.0；P<0.001），并且开具的阿片类药物类型也存在差异（P<0.001）。在接受手术治疗后出院的患者中，标准组和 Lopioid 组之间的阿片类药物再开处方数量存在差异（0.31 对 0.21；P=0.002）。在药物相关并发症的类型（P=0.710）或需要正式疼痛管理咨询的情况（P=0.199）方面没有差异，但 Lopioid 组患者出院时的疼痛评分较低（2.2 对 2.7；P=0.001）。
Lopioid 方案可有效减少骨折手术后出院时 II 类阿片类药物的处方量和阿片类药物的再开处方数量。
