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Papers of the Week

2022 Dec




Multimodal analgesia is superior to opiates alone after tibial fracture in patients with substance abuse history.


To evaluate the effectiveness of multimodal analgesia in patients with a tibial shaft fracture. Retrospective review. Large, urban, academic center. One hundred thirty-eight patients were evaluated before implementation of multimodal analgesia. Thirty-four patients were evaluated after implementation. All patients were treated operatively with internal fixation for their tibial shaft fracture. Patients with polytrauma were excluded. Multimodal analgesia. Pain levels at rest and with movement were assessed. Morphine milligram equivalents (MMEs) dosed per patient were calculated each day. Length of stay was also documented. After implementation of a multimodal analgesic program, there was a statistically significant decrease in pain score at rest (4.7-4.0, = 0.034) and with movement (5.8-4.8, = 0.007). MMEs dosed in the multimodal analgesic program correlated with pain score (R = 0.5), whereas before implementation of the program, MMEs dosed were not dependent on pain score (R = 0.007). Patients with a history of substance abuse had the most profound effect from this paradigm change. For those with a history of substance abuse, treatment of pain using a multimodal approach reduces MMEs dosed and length of stay (5.7-3.1 days, = 0.016). Multimodal analgesia improves patient pain scores both at rest and during movement. In patients with a history of substance abuse, multimodal analgesia not only decreases pain but also decreases length of stay and MMEs dosed to levels consistent with someone who does not have a substance abuse history. Therapeutic Level III.