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

Abstract

<b>Objectives:</b> To evaluate the effectiveness of multimodal analgesia in patients with a tibial shaft fracture. <b>Design:</b> Retrospective review. <b>Setting:</b> Large, urban, academic center. <b>Patients:</b> 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. <b>Intervention:</b> Multimodal analgesia. <b>Main Outcome Measures:</b> 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. <b>Results:</b> After implementation of a multimodal analgesic program, there was a statistically significant decrease in pain score at rest (4.7-4.0, <i>P</i> = 0.034) and with movement (5.8-4.8, <i>P</i> = 0.007). MMEs dosed in the multimodal analgesic program correlated with pain score (R² = 0.5), whereas before implementation of the program, MMEs dosed were not dependent on pain score (R² = 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, <i>P</i> = 0.016). <b>Conclusions:</b> 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. <b>Level of Evidence:</b> Therapeutic Level III.