Strategies aimed at preventing long-term opioid use in trauma and orthopaedic surgery: a scoping review.
C Côté, M Bérubé, L Moore, F Lauzier, L Tremblay, E Belzile, M-O Martel, G Pagé, Y Beaulieu, A M Pinard, K Perreault, C Sirois, S Grzelak, A F Turgeon
Author Information
C Côté: Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), 1401 18e Rue, Québec City, Québec, G1J 1Z4, Canada.
M Bérubé: Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), 1401 18e Rue, Québec City, Québec, G1J 1Z4, Canada. melanie.berube@fsi.ulaval.ca.
L Moore: Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), 1401 18e Rue, Québec City, Québec, G1J 1Z4, Canada.
F Lauzier: Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), 1401 18e Rue, Québec City, Québec, G1J 1Z4, Canada.
L Tremblay: Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5, Canada.
E Belzile: Department of Orthopaedic Surgery, Université Laval, 1050 Avenue de la Médecine, Québec City, Québec, G1V 0A6, Canada.
M-O Martel: Faculty of Dentistry & Department of Anesthesia, McGill University, 1010 Rue Sherbrooke Ouest, Montreal, Québec, H3A 2R7, Canada.
G Pagé: Research Center of the Centre hospitalier de l'Université de Montréal (CRCHUM), 850 rue St-Denis, Montreal, Québec, H2X 0A9, Canada.
Y Beaulieu: Department of Orthopaedic Surgery, Université Laval, 1050 Avenue de la Médecine, Québec City, Québec, G1V 0A6, Canada.
A M Pinard: Department of Anesthesiology and Critical Care Medicine, Université Laval, 1050 Avenue de la Médecine, Québec City, Québec, G1V 0A6, Canada.
K Perreault: Center for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525, boul. Wilfrid-Hamel, Québec City, Québec, G1M 2S8, Canada.
C Sirois: Faculty of Pharmacy, Université Laval, 1050 Avenue de la Médecine, Québec City, Québec, G1V 0A6, Canada.
S Grzelak: Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), 1401 18e Rue, Québec City, Québec, G1J 1Z4, Canada.
A F Turgeon: Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), 1401 18e Rue, Québec City, Québec, G1J 1Z4, Canada.
BACKGROUND: Long-term opioid use, which may have significant individual and societal impacts, has been documented in up to 20% of patients after trauma or orthopaedic surgery. The objectives of this scoping review were to systematically map the research on strategies aiming to prevent chronic opioid use in these populations and to identify knowledge gaps in this area. METHODS: This scoping review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. We searched seven databases and websites of relevant organizations. Selected studies and guidelines were published between January 2008 and September 2021. Preventive strategies were categorized as: system-based, pharmacological, educational, multimodal, and others. We summarized findings using measures of central tendency and frequency along with p-values. We also reported the level of evidence and the strength of recommendations presented in clinical guidelines. RESULTS: A total of 391 studies met the inclusion criteria after initial screening from which 66 studies and 20 guidelines were selected. Studies mainly focused on orthopaedic surgery (62,1%), trauma (30.3%) and spine surgery (7.6%). Among system-based strategies, hospital-based individualized opioid tapering protocols, and regulation initiatives limiting the prescription of opioids were associated with statistically significant decreases in morphine equivalent doses (MEDs) at 1 to 3 months following trauma and orthopaedic surgery. Among pharmacological strategies, only the use of non-steroidal anti-inflammatory drugs and beta blockers led to a significant reduction in MEDs up to 12 months after orthopaedic surgery. Most studies on educational strategies, multimodal strategies and psychological strategies were associated with significant reductions in MEDs beyond 1 month. The majority of recommendations from clinical practice guidelines were of low level of evidence. CONCLUSIONS: This scoping review advances knowledge on existing strategies to prevent long-term opioid use in trauma and orthopaedic surgery patients. We observed that system-based, educational, multimodal and psychological strategies are the most promising. Future research should focus on determining which strategies should be implemented particularly in traumapatients at high risk for long-term use, testing those that can promote a judicious prescription of opioids while preventing an illicit use, and evaluating their effects on relevant patient-reported and social outcomes.
