Do Lidocaine Patches Reduce Opioid Use in Acute Rib Fractures?

Abstract

Background Pain control is an important aspect of rib fracture management. With a rise in multimodal care approaches, we hypothesized that transdermal lidocaine patches reduce opioid utilization in hospitalized patients with acute rib fractures not requiring continuous opioid infusion. Methods We performed a retrospective analysis of adult trauma patients with acute rib fractures admitted to the Trauma Service from January 2011 to October 2018. We compared patients who received transdermal lidocaine patches to those who did not and evaluated cumulative opioid consumption, expressed in morphine milligram equivalents (MMEs). Secondary outcomes included the rate of pulmonary complications and length of hospital stay. Results Of the 21 190 trauma admissions, 3927 (18.5%) had rib fractures. Overall, 1555 patients who received continuous opioid infusion were excluded. Of the remaining 2372 patients, 725 (30.6%) patients received lidocaine patches. The mean total MME of patients who received lidocaine patches was 55.7 MME (30.7 MME on multivariate analysis) and was lower than that of patients who did not receive lidocaine patches ( P ≤ .01). There was no difference in hospital length of stay (no lidocaine patches vs received lidocaine patches: 6.2 days vs 6.5 days, P = .34) or pulmonary complications (1.7% vs 2.8%, P = .08). Discussion In admitted trauma patients with acute rib fractures not requiring continuous intravenous opiates, lidocaine patch use was associated with a significant decrease in opiate utilization during the patients’ hospital course.

Rapid Sample Preparation for Alpha Spectroscopy with Ultrafiltration Membranes

“…Based on the permeability coefficient of the 100 kDa UVMs, 1.2 L h −1 of contaminated groundwater can be filtered at 138 kPa through a 45 mm diameter membrane. If the sample volumes analyzed by Pantchev et al, 7 Gonzales et al, 8 Hanson et al, 18 and Surbeck et al 9 were processed through a selective ultrafiltration membrane, and the analyte recovery remained unchanged, sample preparation would require less than 5 min per sample for our method. From a separations standpoint, the work of Pantchev et al 7 is most comparable to the present work due to the analyte (uranium), concentration of uranium in the feed, feed volume, and the sample matrix (pH neutral potable water).…”

Comprehensive Review of Current Pain Management in Rib Fractures With Practical Guidelines for Clinicians

“…In a retrospective study of 2372 rib fracture patients 725 (30.6%) received lidocaine patches. 17 The mean MME was 58.3 (95% CI 38-78.6) for those that received the patches versus 114 (95% CI 98.7-129.4; P = .01). Ingalls et al 18 looked at 58 patients who had rib fractures and stratified them to receive lidocaine patches in a randomized, double-blind controlled trial with placebo.…”

Acute pain management after trauma: What you need to know

“…31 Evidence supporting the routine use of methocarbamol and lidocaine patches are mixed. [32][33][34][35] Other types of nonnarcotic medications proposed as part of a multimodal pain regimen include lidocaine infusions, hydroxyzine, dronabinol, tricyclic antidepressants, and serotoninnoradrenaline reuptake inhibitors. These medications all need high-quality clinical trials to determine their effectiveness on acute pain after injury.…”

“…The routine use of gabapentin for acute pain is largely unsupported by most randomized trials 31 . Evidence supporting the routine use of methocarbamol and lidocaine patches are mixed 32–35 …”