The following is a summary of “What influences post-operative opioid requirements for tibial fractures?,” published in the June 2024 issue of Pain by Zhang, et al.

The lack of specific opioid prescribing guidelines for orthopedic fractures creates challenges due to the varying pain experiences after different surgeries.

Researchers conducted a retrospective study investigating the association between opioid requirements and tibial fractures.

They analyzed all patients with isolated tibial fractures treated at a major trauma center and operated on within one month of injury (2015-2022). Monthly totals of opioid dosage in morphine milligram equivalents (MME) and duration of opioid use were recorded during the first post-surgical year, reflecting analgesic strength and duration. Variations in opioid requirements were compared based on fracture fixation type, location, fracture type, and patient comorbidities to identify any patterns.

The results showed 1,814 patients with 1,970 fractures, tibial plateau fractures had the highest opioid strength and coverage requirements monthly and yearly (P<.05). The Ex Fix frame showed higher opioid strength and coverage requirements compared to IM nailing and plate ORIF across all fracture locations. Chronic kidney disease (CKD) (ratio: 1.37, 95% CI = 1.19–1.55, P=.002) and hypertension (ratio: 1.34, 95%CI = 1.14–1.53, P=.009) were significant for opioid coverage over one year. CKD (ratio: 1.72, 95%CI = 1.41–2.03, P=.005) and COPD (ratio: 1.90, 95%CI = 1.44–2.36, P=.014) were significant for opioid strength over one year.

Investigators concluded that the analysis of opioid requirements after tibial fracture surgery, considering fracture location, type, surgical approach, and comorbidities, provides a framework for clinicians to anticipate rehabilitation needs and patient’s risk for stratification at the time of injury.

Source: journals.sagepub.com/doi/10.1177/20494637241261013