Limiting Narcotic Utilization Following Ankle Fracture Surgery

This study assessed whether multimodal pain modalities are effective at decreasing narcotic utilization following ankle fracture surgery. A retrospective chart review of opioid-naive patients aged 18 – 65 undergoing ankle fracture surgery was performed. Patients were prescribed a multimodal pain regimen of acetaminophen, ibuprofen, gabapentin, tramadol, and two sealed envelopes each containing a prescription for 10 tablets of hydrocodone/acetaminophen 5/325 mg. Fourteen of 35 (40%) did not fill any hydrocodone/acetaminophen tablets, 14 (40%) fi lled 10, 7 (20%) filled 20, and no patients filled more than 20. Most patients rated their pain favorably at their first postoperative visit. There was no correlation with pain control and number of fractures fixed, obesity, or sex. Previously, the custom and practice at this study’s institution was to prescribe 30 – 50 tablets of hydrocodone/acetaminophen 5/325 mg. Patients needed much less narcotics than previously believed. This study hopes to provide a prescribing guideline that may decrease reliance on opioid analgesia. (Journal of Surgical Orthopaedic Advances 34(1):023-025, 2025)

Key words: postoperative analgesia, ankle fracture, narcotics