PURPOSE: Isolated facial fractures pose a challenge to the craniofacial surgeon. We hypothesize that isolated facial fractures have high narcotic requirements. In the midst of opioid misuse and rising rates of opioid overdose-related deaths, the surgeon must identify strategies to reduce opioid consumption. The purpose of this study was to characterize rates of narcotic usage following hospital admission for isolated traumatic facial fractures and to evaluate if previous substance use or the use of non-narcotic adjuncts may affect narcotic consumption.
METHODS: A retrospective chart review was conducted to assess narcotic use in patients with isolated craniofacial fractures undergoing intervention between 2015 and 2018 at a level I trauma center. Data were collected on patient demographics, mechanism of injury, injury severity score, recent alcohol and recreational drug use, narcotic use, and non-narcotic analgesic use. Analysis of narcotic usage variance (controlled for sex and race) was conducted across these variables. A linear regression model was constructed to examine the impact of non-narcotic analgesic use on narcotic usage in various settings.
RESULTS: Thirty-six patients met eligibility criteria (mean age, 40.5 years). Study participants were predominantly male (83.3%), white (36.1%), and remained hospitalized for an average of 3.3 days. The average morphine milligram equivalent (MME) use during inpatient stay was 997.0. Total narcotic use across inpatient, intraoperative, and outpatient settings was 1,266.9 MME. Race and gender were not predictive of amount of narcotic use. Significant variations in rates of narcotic use in the inpatient setting were found based on mechanism of injury (P < 0.0001), operative intervention (P = 0.04), injury severity score (P = 0.013), and during the 24-hour postoperative period (P = 0.005). Recent alcohol use, as defined by serum levels >11 mg/dl at admission, was also associated with increased narcotic use in the inpatient setting (P = 0.002). Recent use of other recreational substances and history of drug abuse did not seem to impact narcotic usage rates. For those patients who received gabapentin (N = 4), mean narcotic usage was 578.1 MME less in the inpatient setting and 141.9 MME less in the outpatient setting compared to patients who did not receive gabapentin (N = 32). Due to small sample size, evaluation of the significance of this difference was not possible. Use of other non-narcotic analgesics, including acetaminophen and lidocaine, was not predictive of amount of narcotic use in the perioperative setting.
CONCLUSIONS: Recent alcohol use seems to influence the rate of narcotic use following isolated traumatic facial fractures. Recent use of other recreational substances and history of drug abuse did not seem to impact narcotic usage rates. Non-narcotic adjuncts trended toward reduction in narcotic use; however, the study lacked power for statistical significance. Further study with prospective implementation of a narcotic reduction protocol will follow at this institution.