AAOS 2026: Multimodal Pain Protocol vs. Hydrocodone-Acetaminophen After Orthopaedic Trauma Surgery .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2026;14(5):41Eighty patients with isolated orthopaedic injuries undergoing outpatient orthopaedic trauma surgery were analyzed to receive either a peripheral nerve block with a multimodal pain protocol consisting of ibuprofen, acetaminophen, gabapentin, and oxycodone (n=41) or a peripheral nerve block with hydrocodone-acetaminophen (n=39). The primary outcome of interest was postoperative opioid consumption measured as morphine milligram equivalents (MMEs). Secondary outcomes of interest included patient-reported visual analog pain scores, patient satisfaction, and perceived effectiveness of individual pain management interventions. Outcomes were assessed at 4 and 14 days postoperatively. Overall, the results of the study revealed no statistically significant difference in cumulative MME consumption between the multimodal and monotherapy groups at either 4 days (P=0.36) or 14 days (P=0.62) after surgery, and there were also no differences in pain scores or patient satisfaction. These findings suggest that when peripheral nerve blocks are used, multimodal pain regimens may not significantly reduce opioid consumption compared with opioid monotherapy in outpatient orthopaedic trauma surgery.
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Why was this study needed now?
The opioid epidemic remains a major public health concern, and postoperative opioid prescribing practices are under increasing scrutiny. Multimodal analgesic regimens have been widely promoted to reduce opioid requirements after surgery. However, limited evidence exists specifically for patients undergoing outpatient orthopaedic trauma procedures. Therefore, this study was conducted to evaluate whether a multimodal pain management strategy provides improved pain control or reduced opioid consumption compared with traditional opioid-based therapy in this patient population.
What was the principal research question?
In patients with isolated orthopaedic injuries undergoing outpatient orthopaedic trauma surgery, does a multimodal pain protocol including ibuprofen, acetaminophen, gabapentin, and oxycodone in addition to a peripheral nerve block, compared with only hydrocodone-acetaminophen with a peripheral nerve block, reduce postoperative opioid consumption measured in morphine milligram equivalents within 14 days after surgery?
- There was no statistically significant difference in cumulative opioid consumption between the control and intervention groups at 4 days (P=0.36) or 14 days (P=0.62) postoperatively. The average daily MME consumption was 3.67 in the monotherapy group and 4.15 in the multimodal group (P=0.266). Additionally, no differences were observed in postoperative pain scores or patient satisfaction across time points. Patients in both groups rated the peripheral nerve block as the most effective pain control intervention (P<0.00001). These results highlight that multimodal analgesia did not reduce opioid consumption compared with opioid monotherapy when peripheral nerve blocks were utilized.
What should I remember most?
A multimodal analgesic regimen did not significantly reduce opioid consumption or improve pain outcomes compared with hydrocodone-acetaminophen when peripheral nerve blocks were used after outpatient orthopaedic trauma surgery. Clinically, these findings suggest that effective regional anesthesia combined with limited opioid prescribing may provide adequate postoperative pain control. Key limitations of the study were the relatively small sample size and the single-centre design.
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