Schedule II Narcotics are often Unnecessary for Pain Control in Patients with Pelvic or Acetabular Fractures

Objectives: Determine if patients with pelvic and acetabular fractures require scheduled II narcotics after discharge.   Design: Retrospective case series.   Setting: Level I Trauma Center   Patients: 124 consecutive patients with operatively managed pelvic (OTA 61B or C) and acetabular fractures (OTA 62A, 62B or C)   Intervention: A multimodal oral pain regimen was prescribed at discharge with schedule II narcotic only if needed for pain control.   Main Outcome: Primary outcomes were defined as the need for schedule II narcotic at discharge or in follow up. Measurements: Prescription of narcotic on follow up or return to ER for inadequate pain control. Visual Analog Pain Scale score.   Results: Ninety-two patients (74%) with adequate follow-up were included for the final analysis, including patients with 25 acetabular fractures, 50 pelvic fractures, and 17 combined injuries.  Sixty-four patients (69.6%) were multiply-injured patients. Four (4.3%) patients were discharged with a Schedule II narcotic. Of the remaining patients (n=88), two (2.2%) required delayed prescription of a Schedule II narcotic after discharge and 5 (5.4%) presented to the ED for pain control. There were no readmissions for pain. Overall 81 of 92 (88.0%) patients had pain controlled without schedule II narcotics or ED presentation.  The mean VAS pain score for all patients was 4.1±3.6 from 5 to 21 days, 3.2±3.4 at 22 to 60 days, and 2.7±3.3 at greater than 60 to 180 days after discharge, there was no significant difference between groups   Conclusion: Multimodal pain control regimens without schedule II narcotics in the immediate postoperative follow-up period can be effective in managing pain in the majority of patients with pelvic or acetabular fractures.   Level of Evidence: IV; case series   Keywords: narcotics, pain control, acetabular fractures, pelvic fractures