Decreasing Postoperative Opioid Prescriptions After Orthopedic Trauma Surgery: The “Lopioid” Protocol

Abstract

Abstract Objective To assess the effectiveness of a multimodal analgesic regimen containing “safer” opioid and non-narcotic pain medications in decreasing opioid prescriptions after surgical fixation in orthopedic trauma. Design Retrospective cohort study. Setting One urban, academic medical center. Subjects Patients with traumatic fracture from 2018 (n=848) and 2019 (n=931). Methods In 2019, our orthopedic trauma division began a standardized protocol of postoperative pain medications that included 50 mg of tramadol four times daily, 15 mg of meloxicam once daily, 200 mg gabapentin twice daily, and 1 g of acetaminophen every 6 hours as needed. This multimodal regimen was dubbed the “Lopioid” protocol. We compared patients who received this protocol with all patients from the prior year who had followed a standard protocol that included Schedule II narcotics. Results Greater mean morphine milligram equivalents were prescribed at discharge from fracture surgery under the standard protocol than under the Lopioid protocol (252.3 vs 150.0; P < 0.001), and there was a difference in the type of opioid medication prescribed (P < 0.001). There was a difference in the number of refills filled for patients discharged with opioids after surgical treatment between the standard and Lopioid cohorts (0.31 vs 0.21; P = 0.002). There were no differences in the types of medication-related complications (P = 0.710) or the need for formal pain management consults (P = 0.199), but patients in the Lopioid cohort had lower pain scores at discharge (2.2 vs 2.7; P = 0.001). Conclusions The Lopioid protocol was effective in decreasing the amount of Schedule II narcotics prescribed at discharge and the number of opioid refills after orthopedic surgery for fractures.