Introduction. Introduction. Demonstration of an Effective Post-Op Pain Management Protocol In Distal Radius Fractures

Transcription

1 Demonstration of an Effective Post-Op Pain Management Protocol In Distal Radius Fractures Demonstration of an Effective Post-Op Pain Management Protocol In Distal Radius Fractures David L. Nelson, MD Brandan La Nothing to disclose 1990: 4 tons 2009: 39 tons Patients want to have as little pain postop International Association for the Study of Pain (IASP) Veterans Administration 1999 fifth vital sign JCAHO 2001 rigorous pain standards Physicians responded prescribing opioids Patients want to have little postop pain Veterans Administration 1999 fifth vital sign JCAHO 2001 rigorous pain standards Physicians responded 99% by prescribing used in opioids the US CDC,

2 Opioid Epidemic Patients want to have little postop pain International Association for the Study of Pain (IASP) Veterans Administration 1999 fifth vital sign JCAHO 2001 rigorous pain standards Physicians responded by prescribing opioids Opioid Epidemic Hydrocodone (Vicodin) most widely prescribed drug in the US 100 million prescriptions per year 2007 Legal prescription opioids kill more Americans than heroin or cocaine (CDC data) 2

3 Quandry 2010: Opioid overdose deaths > Patients want to have great postop pain < > There is an opioid epidemic in US Deaths due to heroin/cocaine Deaths due to trauma (CDC data) 3

4 Goal Study Design Test an established pain management protocol Common, moderately painful procedure Performed in nearly identical manner in the US That could be used to assess orthopedic surgeon s pain management protocol Initiate a conversation regarding post op pain managment Prospective consecutive series of distal radius fxs Postoperative pain managed according to protocol Pain Management Protocol Pain Management Protocol Protocol developed in 1999 International Association for the Study Pain Preop counselling regarding pain Face-to-face discussion Handout Webpages with didactic material and patient statements Long-acting acetaminophen + NSAID AM of surgery Pre-incision block with lido + epi Post-surgical block with bupivicaine + epi Long-acting acetaminophen + NSAID BID x 2 then prn Hydrocodone/acetaminophen for breakthrough pain Post-Op Day 1 follow-up telephone call 4

5 Measure of Protocol Effectiveness Number of rescue medication (hydrocodone) taken in 10 days Outcome measure is patient-centric: only the patient decides if they are having enough pain to require opioids; MD not involved in decision 72 patients eligible Exclusion criteria Multiple trauma Already on opioid medication Could not remember how many taken 59 patients met entry criteria and entered into study Results Results Study Validation Average number of hydrocodone taken within 10 days: Senior hand surgeon reviewed the study data 0.68 pills 1. Surgical logbook reviewed to verify consecutive series 2. Charts reviewed to verify that the database is correct 3. Patients were contacted to verify that the data in the chart The study is accurate 0.68 hydrocodone/10 days after an ORIF radius fracture 5

6 Conclusion Discussion The pain management protocol effectively controls pain in a prospective study of a moderately painful surgery, as measured by the quantity of hydrocodone taken Protocol serve as a model upon which other surgeons can design a pain management protocol that fits their practice situation Distal radius fractures might be used as an index surgery by surgeons to assess the effectiveness of their pain management If surgeons assess and improve their effectiveness while at the same time less opioid medication may be prescribed, decrease physician contribution to the Opioid Epidemic Discussion 6