Factors affecting upper limb fracture opioid requirements

Introduction: Understanding varying opioid pain relief needs in upper limb fracture patients is crucial for evidence-based guidelines and responsible prescribing. We investigated predictors of opioid requirements in this context.

Methods: Over seven years, we examined all upper limb fractures from shoulder to wrist at a major trauma center. Data collected included fracture location, demographics, comorbidities, and management. We calculated monthly post-injury opioid prescriptions in the first year, converted to morphine milligrams equivalents (MME). "Coverage" (days requiring medication) and "strength" were assessed.

Results: Our study included 6,413 patients with 9,125 fractures, averaging 436 MME. Apart from the first post-injury month, no significant differences in strength or coverage were observed between operative and non-operative treatments.

Fractures in the scapula, proximal humerus, humerus shaft, distal humerus, and proximal ulna had significantly higher MME requirements at one year. Conversely, the radius shaft, distal radius, and ulna shaft had lower MME requirements.

Patients with depression, diabetes, drug abuse history, obesity, pulmonary circulatory disorders, and rheumatological conditions required stronger opioids at one year. Those with chronic kidney disease, depression, pulmonary circulation disorders, and rheumatological conditions needed more extensive opioid coverage.

Conclusion: Our study provides a detailed breakdown of opioid requirements during upper limb fracture rehabilitation. We identified high-demand fracture locations and comorbidities influencing medication needs. This framework equips clinicians and patients to anticipate rehabilitation more accurately and stratify risk effectively at the injury's outset.

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