Pain Management for Patients Following Open Reduction Internal Fixation of Distal Radius Fractures
Steven R Niedermeier, MD1; Sonu A. Jain, MD, FACS2; Krystin Hidden, MD1; Nisha Crouser, BS1; (1)Ohio State University, Columbus, OH, (2)Departments of Plastic Surgery and Orthopaedic Surgery, The Ohio State University, Columbus, OH
Distal radius fractures remain one of the most common operative injuries to the upper extremity. Postoperative pain medication regimens vary, depending on patient factors, perioperative anesthetics, and physician preference. Opioids remain a common choice for pain control despite the current trend toward abuse and overdose. The purpose of this study is to evaluate common post-operative pain medications prescribed for open reduction internal fixation (ORIF) of distal radius fractures in relation to the number of physician hotline phone calls regarding pain control post-operatively. We hypothesize that a more formal, standardized post-operative pain protocol will decrease the number of patient calls due to poor pain control and increase overall patient satisfaction.
A retrospective chart review was conducted for consecutive outpatient and short stay procedures for ORIF of distal radius fractures from December 1, 2012 through December 31, 2014. Patient demographics, fracture laterality, severity of fracture (based on CPT® code), type of operative anesthesia, and post-operative oral pain medications were recorded. Simple descriptive proportions and statistics were used with a z-test significance value of < 0.05.
294 patients were identified as having had an ORIF of a distal radius fracture. 146 (51%) patients received short acting narcotics, 123 (43%) patients received short acting narcotics and a nonsteroidal anti-inflammatory drug (NSAID), 13 (5%) patients received a short and a long acting narcotic, and only 2 (1%) received a short and long acting narcotics and an NSAID. 66 (22.4%) patients called the physician hotline regarding poor pain control (101 total calls) within 15 days of surgery (range = 1-90 days). The average number of phone calls per patient 1.6 per person. Of the patients who called regarding pain control, 32 patients (48.5%) received short acting narcotics alone and 31 patients (47%) received a combination of short acting narcotics and NSAIDs. 128 patients required a refill on their pain medication. The use of general anesthesia or regional anesthesia were not correlated with phone calls regarding pain control or need for a refill of narcotic pain medication.
Surgical fixation of distal radius fractures is common, and post-operative pain regimens vary. A standardized protocol for preoperative expectations, perioperative discharge instructions, and postoperative pain management may help alleviate the physician hotline phone calls received and increase overall patient satisfaction. Adding an anti-inflammatory in the acute post-operative setting may help with immediate objective pain control after surgery.
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