Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma

Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review

“…The key characteristics of the 66 included studies [ 5 , 50 – 114 ] are detailed in Table 1 : Study Characteristics, Description of Strategies and Outcomes. Most studies used a retrospective cohort ( n = 35) [ 5 , 52 , 56 , 60 , 72 – 74 , 78 – 89 , 91 – 94 , 97 – 99 , 101 – 105 , 108 , 109 , 111 , 112 ], a randomized controlled trial (RCT) ( n = 24) [ 50 , 51 , 53 – 55 , 57 , 59 , 61 , 62 , 65 – 71 , 75 , 76 , 95 , 100 , 106 , 107 , 113 , 114 ] or a prospective cohort ( n = 7) [ 58 , 63 , 64 , 77 , 90 , 96 , 110 ] design. Almost all the studies were conducted in the U.S. ( n = 58) [ 5 , 50 – 57 , 59 – 61 , 63 , 67 – 74 , 77 – 99 , 101 – 114 ].…”

“…Most of the selected studies (62.1%) focused on the elective orthopaedic surgery population who underwent procedures to the limbs [ 50 , 51 , 54 , 56 – 59 , 61 , 62 , 64 , 65 , 67 , 68 , 70 – 74 , 76 , 78 , 82 , 84 , 88 – 92 , 95 , 102 – 114 ]. The remaining studies targeted trauma populations (18.2%) [ 5 , 63 , 66 , 75 , 87 , 93 , 94 , 96 , 98 – 101 ] or a mix of trauma and elective orthopaedic surgical patients (12.1%) [ 52 , 53 , 55 , 77 , 79 , 80 , 86 , 97 ], and patients who underwent spine surgery performed by orthopaedic or neurosurgeons (7.6%) [ 60 , 69 , 81 , 83 , 85 ].…”

“…The educational strategies comprised seven studies on strategies aimed at providing patient information on the adequate use of opioids ( n = 6) [ 5 , 50 , 51 , 53 , 100 , 107 ] or aimed as a reminder to professionals on opioid prescribing guidelines ( n = 1) [ 52 ]. The multimodal strategies included eight studies testing strategies on multiple analgesic regimens or a combination of pharmacological and non-pharmacological strategies [ 56 – 58 , 68 , 84 , 101 , 108 , 110 ] and a transitional pain service [ 133 ]. Finally, five studies focused on the effect of surgical techniques (e.g., different surgical approaches [ 59 – 61 , 111 ]) or inpatient vs. outpatient surgery [ 112 ]; two on an alternative pain management strategy (i.e., acupuncture) [ 54 , 55 ], and three on a psychological strategy (i.e., Acceptance and Commitment Therapy [ 95 ], motivational interviewing [ 114 ] or mindfulness [ 113 ].…”

“…The most commonly measured outcome was the quantity of opioids in morphine equivalent doses (MEDs) ( n = 44) [ 53 , 55 – 59 , 61 , 63 , 68 , 70 , 72 , 74 – 77 , 79 – 87 , 89 – 93 , 96 – 108 , 110 , 111 ], generally measured at 6 weeks or 1, 3 and 6 months. The proportion of patients using opioids was the second most frequently used outcome measure in the selected studies ( n = 25) [ 5 , 53 , 57 , 58 , 62 – 65 , 67 , 69 , 72 , 73 , 78 , 81 , 86 , 94 , 96 , 100 , 101 , 105 , 107 , 109 , 112 , 114 , 134 ] and this evaluation was often conducted at 3 ( n = 13) [ 5 , 53 , 57 , 62 , 63 , 65 , 72 , 81 , 94 , 100 , 105 , 112 , 114 ] and 6 months ( n = 6) [ 64 , 67 , 78 , 101 , 114 ]. The least frequently measured outcome was the proportion of patients who received an opioid prescription refill ( n = 18) [ 57 , 68 ,…”

“…None of the studies measured illicit opioid use or opioid diversion (i.e., opioid diverted from siblings who have legitimate prescriptions). Data came from patient records or clinical-administrative databases ( n = 27) [ 5 , 60 , 73 , 74 , 78 – 81 , 83 – 89 , 91 , 94 , 98 , 101 – 105 , 108 , 110 , 112 , 114 ], or a combination of these methods, and from patient self-report ( n = 17) [ 53 , 55 , 58 , 62 , 63 , 65 , 68 , 71 , 72 , 77 , 82 , 90 , 96 , 100 , 107 , 109 , 113 ] in many studies. The remaining studies measured outcomes from self-reported data only ( n = 5) [ 50 , 54 , 67 , 69 , 95 ] or did not clearly describe the data source ( n = 17) [ 51 , 52 , 56 , 57 , 59 , 61 , 64 , 66 , 70 , 75 , 76 , 92 , 93 , 97 , 99 , 106 , 111 ].…”