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Developing a Pathway Toward Non-Narcotic Analgesia in Facial Trauma Management
Vikas S. Kotha MD, Corrine Wee MD, Marco Swanson MD, Edward H. Davidson MD
Case Western Reserve University
2021-02-15
Presenter: Vikas S. Kotha MD
Affidavit:
100% of this project represents the original work of the resident
Director Name: Edward Davidson
Author Category: Other Specialty Resident
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Background: This study aimed to prospectively asses impact of a non-narcotic protocol in facial trauma perioperative analgesia.
Methods: A narcotic-minimizing perioperative analgesia protocol was implemented for isolated mandible fracture patients. The protocol comprised of non-opioid pharmacotherapy prescribed pre- and post-operatively (acetaminophen 650-1000mg, celecoxib 200-400mg, gabapentin 150-300mg) and intravenous ketorolac 30mg and dexamethasone 8mg given intraoperatively. Oxycodone (5-10mg) was reserved for severe uncontrolled pain and five oxycodone 5mg pills were prescribed at discharge; refills first required evaluation to rule out surgical complications. Postoperative morphine milligram equivalents (MME) consumed, opioid refill requests, and Visual Analog Scale (VAS) pain scores (0-10) were prospectively tracked and compared with retrospective data from comparable mandible fracture patients prior to introduction of the narcotic-minimizing perioperative analgesia protocol, as well as to elective orthognathic surgery patients. Differences in means were calculated using SPSS27.
Results: Ten patients were included. Median discharge was POD1. Patients reported an overall postoperative pain score of 5.3 (VAS 0-10). Median VAS pain score was 8 at the time of POD0 ward transfer and 4.5 on the day of discharge. Nine patients reported satisfaction with their pain plan. No opioid refills were requested after discharge. Total postoperative opioid consumption was 19.8 MME and 24-hour consumption was 11.3 MME. Opioid consumption was statistically significantly less compared to both the elective orthognathic surgery cohort (106 MME) and traditional pain management facial trauma cohort (118.6 MME) (mean difference -104, -124.5).
Conclusion: A non-narcotic analgesia protocol significantly reduces opioid use in perioperative facial trauma management without sacrificing satisfactory pain control for patients.
