Morphine use in fractures

AIMS: Pain can create physical and psychosocial discomfort. Pain management of patients with opioid misuse history can be challenging, in part due to their tolerance to opioids. Clonidine is an alpha-2 agonist that has been used for the reduction of anxiety and pain. The aim of this study was to investigate the effect of oral clonidine on pain outcomes in patients with a history of opioid use disorder presenting with orthopedic fractures in the emergency room. METHODS: In this blinded clinical trial in the emergency department, 70 opioid-dependent patients with orthopedic fractures were divided into a control group of 35 and an intervention group of 35 subjects...

OBJECTIVES: The primary objective was to compare the analgesic efficacy of ultrasound-guided erector spinae plane block (ESPB) with a sham procedure in adult patients presenting with rib fractures to the emergency department (ED). METHODS: A randomized controlled trial was conducted at an academic ED over a 17-month period. Forty-six adults with confirmed rib fractures and numeric rating score (NRS) greater than 4 were randomized to one of two treatment arms: ultrasound-guided ESPB group or placebo (sham procedure)...

OBJECTIVE: To determine whether scheduled low-dose, short-term ketorolac is associated with reduced length of stay, opioid use, and pain in orthopaedic polytrauma patients. DESIGN: Double-blinded, randomized controlled trial. SETTING: One Level 1 trauma center. PATIENTS: From August 2018 to October 2022, 70 orthopaedic polytrauma patients between 18-75 years-old with a New Injury Severity Score (NISS) > 9 were randomized...

OBJECTIVE: Patients with blunt thoracic trauma requiring surgical stabilization of rib fractures (SSRF) frequently experience severe pain. Further, a rising prevalence of opioid-tolerant patients sustain traumatic injuries. The optimal pain management adjunct for concurrent use with SSRF remains uncertain. This study compared outcomes in patients undergoing SSRF with concomitant cryonerve block (CryoNB) or ropivacaine 0.2% elastomeric infusion pump (EIP). METHODS: A single-center retrospective comparative analysis was performed at a level II trauma center...

INTRODUCTION: Femoral neck fractures are common orthopaedic fractures, especially in old age, and they represent a life-threatening condition requiring surgical intervention. In this study, we aimed to compare 2 regional techniques used to decrease perioperative pain. MATERIAL AND METHODS: In this parallel group randomized controlled clinical trial we enrolled 68 patients from both sexes scheduled for hip surgery after femoral neck fractures. The patients were randomly allocated to 2 equal groups with one receiving ultrasound- guided supra-inguinal fascia iliaca block (FIB) and the other receiving ultrasound- guided anterior quadratus lumborum block (QLB)...

BACKGROUND: Most patients with hip fractures are elderly patients with comorbidities, and well-managed pain management is associated with positive postoperative outcomes. In recent years, new indications for regional anesthesia techniques have been defined, and they have found more place in clinical practice. Herein we investigate the effect of US-guided PENG block on positioning pain and compare that effect to intravenous opioid in patients undergoing surgery under spinal anesthesia for hip fractures...

BACKGROUND AND IMPORTANCE: Ultrasound-guided femoral nerve block (FNB) could be used as part of a multimodal preoperative pain management for patients with hip fracture. Evidence of the effects of its early implementation in the emergency room as an immediate alternative to intravenous morphine titration is sparse. OBJECTIVE: To investigate the effect of an early ultrasound-guided FNB performed by emergency physicians on preoperative opioid consumption, compared to standard pain management...

PURPOSE: To identify the mean morphine milligram equivalent (MME) opioid prescriptions for opioid-naïve patients undergoing isolated anterior cruciate ligament reconstruction (ACLR) between 4 weeks before surgery and the first 90 days after surgery and to describe opioid prescriptions filled per patient and mean MMEs per year within 90 days following ACLR. METHODS: Exclusion criteria were patients having concurrent other cruciate or collateral ligament repair or reconstruction, meniscus procedures (repair and debridement), any cartilage procedure, lower-extremity osteotomy, or knee procedures for fracture, infection, or neoplasms; patients with substance use disorder or chronic pain also were excluded...

BACKGROUND: Surgical treatment of proximal femur fractures is complicated by postoperative delirium in about one-third of patients. Pain and opioid consumption are modifiable factors that may influence the incidence of delirium.1 An intrathecal injection of morphine may lead to a reduction in postoperative pain and reduced systemic opioid consumption. In current practice, the addition of morphine to intrathecal anaesthesia is commonly used but depends on the anaesthesiologist's preference...

OBJECTIVE: We evaluated the incidence rate and factors associated with fractures among adults with ankylosing spondylitis (AS). METHODS: We performed a retrospective cohort study with data from the Rheumatology Informatics System for Effectiveness (RISE) registry linked to Medicare claims from 2016-2018. Patients were required to have two AS ICD codes, ≥30 days apart, and a subsequent Medicare claim. Then, one year of baseline characteristics were included, after which patients were observed for fractures...

BACKGROUND AND AIMS: Pain associated with rib fractures is challenging to manage. This pilot trial aimed to assess the efficacy of erector spinae plane block (ESPB) compared with thoracic epidural analgesia (TEA) for controlling pain associated with multiple rib fractures. METHODS: This randomised, single-blinded, controlled pilot study was conducted on trauma patients who had three or more rib fractures and had been admitted at a tertiary care centre. The study was conducted after receiving ethical approval and trial registration...

Hip fractures are costly, and associated complications are the leading cause of injury-related deaths in persons 65 years or older. Pain medications in this population can be more potent, have a longer duration of action, and have serious side effects (Chau et al., 2008). Hip fractures are projected to reach 6.26 million worldwide by 2050 (Gullberg et al., 1997; Kannus et al., 1996). Morrison et al. (2003) report that uncontrolled pain leads to increased hospital length of stay (LOS), delayed physical therapy, and long-term functional impairment...

STUDY OBJECTIVE: The objective of this work is to describe the risk of fracture in adults aged 17 to 64 years across categories of daily opioid dose. DESIGN: A retrospective analysis of insurance claims data. DATA SOURCE: Information from a private health insurance provider for the years 2003-2014 for enrolled individuals living in Iowa. PATIENTS: Patients who were aged 17 to 64 years and prescribed an opioid were followed for the length of opioid treatment plus 30 days to determine whether a fracture occurred...

OBJECTIVES: Intertrochanteric fracture is a common fracture that mainly occurs in the elderly. Diverse pain management strategies have been applied; however, considering the age of the patients, analgesia-related complications should be concisely considered. The current study aims to evaluate the efficacy and adverse effects of Ketorolac plus placebo versus Ketorolac plus magnesium sulfate for pain management in intertrochanteric fractures. METHODS: The current randomized clinical trial has been conducted on 60 patients with intertrochanteric fractures assigned into two groups of treatment with Ketorolac (30 mg) plus placebo (n=30) versus Ketorolac (30 mg) plus magnesium sulfate (15 mg/kg) (n=30)...

OBJECTIVES: To determine if the use of Peripheral Nerve Block (PNB) versus Local Infiltration Analgesia (LIA) for hip fracture patients, affected opioid consumption in the early post-operative period. DESIGN: Retrospective cohort study SETTING: Two level 1 trauma centers PATIENTS/INTERVENTION: 588 patients with surgically treated AO/OTA 31A and 31B fractures between February 2016-October 2017 were included. 415 (70.6%) received general anesthesia (GA) alone, 152 received GA plus perioperative PNB (25...

OBJECTIVES: To compare perioperative, 90-day, and 1-year postoperative complications and outcomes between the direct anterior approach (DAA) and posterior approach (PA) for total hip arthroplasty (THA) in geriatric patients with displaced femoral neck fractures (FNF). DESIGN: Retrospective Cohort Study. SETTING: Multicenter Healthcare Consortium. PATIENTS: 709 patients > 60 years of age with acute displaced FNF between 2009 and 2021...

BACKGROUND: Real-world data on optimal cancer pain management remain scarce. We describe prescription patterns of analgesics in Japanese cancer patients with bone metastases. METHODS: National hospital-based claims data were analyzed. Adults with first diagnosis of cancer during 2015-2019 and first diagnosis of bone metastasis after the initial cancer diagnosis were included. Skeletal-related events (SREs) were identified with disease and receipt codes. RESULTS: Among the 40,507 eligible patients (age [mean ± SD], 69...

OBJECTIVES: To evaluate the efficacy of an intraoperative, post-fixation fracture hematoma block on postoperative pain control and opioid consumption in patients with acute femoral shaft fractures. DESIGN: Prospective, double-blinded, randomized controlled trial. SETTING: Academic Level I Trauma Center.Patients/Participants: 82 consecutive patients with isolated femoral shaft fractures (OTA/AO 32) underwent intramedullary rod fixation. INTERVENTION: Patients were randomized to receive an intraoperative, post-fixation fracture hematoma injection containing either 20 mL of normal saline or 0...

BACKGROUND: Ensuring safe and effective analgesic use in residential aged care services is important because older adults are susceptible to analgesic-related adverse drug events (ADEs). OBJECTIVE: The aim of this study was to identify the proportion and characteristics of residents of aged care services who may benefit from analgesic review based on indicators in the 2021 Society for Post-Acute and Long-Term Care Medicine (AMDA) Pain Management Guideline. METHODS: Cross-sectional analyses of baseline data from the Frailty in Residential Sector over Time (FIRST) study (N = 550 residents) across 12 South Australian residential aged care services in 2019 were conducted...

BACKGROUND: Opioids are effective in short-term pain treatment; however, their long-term effectiveness is unconfirmed. Many patients are exposed to opioids after pelvic injuries with little known about persistent use afterward. We assessed the prevalence and predictors of long-term opioid use following pelvic fractures. MATERIALS AND METHODS: This retrospective study enrolled 277 patients with acute pelvic fractures over five years. Daily and total morphine milligram equivalents (MME) were calculated...