Improving Opioid Prescribing Post-Discharge for Trauma Patients With Rib Fractures: Factors in Prevention of Prolonged Use and Dependency

Background Rib fracture (RF) pain management provides analgesia while reducing opioids. We postulated: (1) Prescriber factors affect opiate duration, and (2) lidocaine infusion curtails dependency. Materials and Methods Retrospective study of RF patients undergoing multimodal analgesia at ACS-verified Level 1 Trauma Center April 2018-February 2020. Exclusions: age<18 y/o, GCS < 14, hospital length of stay (LOS) <3 d, <3 RF, ventilator support, injury-related mortality, disclosed/discoverable, acute/chronic opiate Rx within 90 days preadmission, substance abuse, patient inaccessible via Controlled Substance Monitoring Database (CSMD), and/or not using opioids in-/post-hospitalization. CSMD queried regarding opioid prescriptions filled by cohort. Cohort variable analysis performed on SPSS Version 27sf (Armonk, NY: IBM Corp). Results 153 patients included - 113 (74%) stopped opiates by 30 days post-discharge (NORx30), 40 (26%) continued beyond 30 days (Rx+). No significant differences in age, gender, ISS, number of RF, bilaterality, flail chest, and discharge disposition. Significant differences included hospital LOS (7.62 NORx30 vs. 10.22 Rx+, p = .02), number of prescribers (1.73 NORx30 vs. 2.98 Rx+, p < .01), average MME/day during initial 30 days post-discharge (36.7 +/- 17 NORx30 vs. 45.4 +/- 30.2 Rx+, p = .03), and number of pills (49 +/- 38 NORx30 vs. 120 +/- 85 Rx+, p < .01). Patients who received lidocaine infusion (LIDO+) had lower MME/day prescribed (32.24 +/- 19.9, p = .03), were younger (61.2 vs. 65.6, p < .01), had more RFs (7.1 vs. 6.05, p = .03), and shorter LOS (7.71 vs 10.2, p = .01). Discussion Prescriber attention to MME/day and number of pills dispensed affects opioid dependency. We recommend 35-40 MME/day with 50 pill/month limit prescribed by a single provider monitoring patient and CSMD. Early LI offers post-discharge opioid cessation advantage.

Automated summary

This study retrospectively analyzed pain management and opioid use in patients with rib fractures. The study found that prescriber factors can affect the duration of opioid use, while lidocaine infusion can reduce dependence. It is recommended that prescribers pay attention to the daily equivalent opioid dose and number of pills in prescriptions, and early lidocaine infusion is recommended to reduce post-discharge opioid use.