Comparison of post-op opioid use and pain between short and long cephalomedullary nails in elderly intertrochanteric fractures

Purpose It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid...

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Published in:European journal of orthopaedic surgery & traumatology 2023-10, Vol.33 (7), p.3135-3141
Main Authors: Pectol, Richard W., Kavolus, Matthew W., Kiefer, Axel, Sneed, Chandler R., Womble, Tanner, Foster, Jeffrey A., Kinchelow, Daria L., Hawk, Gregory S., Matuszewski, Paul E., Landy, David C., Aneja, Arun
Format: Article
Language:English
Subjects:
Medicine
Medicine & Public Health
Narcotics
Original Article
Pain
Surgical Orthopedics
Traumatic Surgery
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Summary:Purpose It remains unknown if cephalomedullary nail (CMN) length has an impact on pain and opioid use following fixation. Given the lack of level I evidence favoring a specific CMN length to prevent adverse surgical outcomes, we investigated if CMN length impacts acute postoperative pain and opioid use. The authors hypothesize that the use of longer CMNs results in increased pain scores and morphine milligram equivalents (MME) intake during the 0–24 h (h) and 24–36 h postoperative period. Methods A retrospective chart review was performed from 2010 to 2020 of patients ≥ 65 years-old who underwent CMN for IT fractures and fractures with subtrochanteric extension (STE). We compared patients who received short and long CMNs using numeric rating scale (NRS) pain scores and MME intake at 0–24 h and 24–36 h postoperatively. Results 330 patients receiving short (n = 155) and long (n = 175) CMNs met criteria. CMN length was found to not be associated with higher pain scores in the early postoperative phase. However, patients with long CMNs received higher MME from 0–24 h (25.4% estimated mean increase, p value = 0.02) and 24–36 h (22.3% estimated mean increase, p value = 0.04) postoperatively, even after adjusting for covariates, gender, and age. Conclusion Patients with long CMNs received greater MME postoperatively. Additionally, differences in pain and MME were not significantly different between patients with and without STE, suggesting our findings were not influenced by this pattern. These results suggest longer CMNs are associated with higher acute postoperative opioid intake among patients with IT fractures. Level of evidence Therapeutic level III.
ISSN:1432-1068
1633-8065
1432-1068
DOI:10.1007/s00590-023-03553-7