Patients who have surgically managed fractures are commonly discharged with a strong opioid prescription. However, increased initial opioid exposure is associated with a greater risk of long-term use, misuse, and overdose. A superiority trial was undertaken to determine whether a strong opioid provided better analgesia than a mild opioid when taken after discharge by patients who had orthopedic surgical treatment.

At discharge, 120 patients who were age 18 or older and had sustained at least one acute fracture requiring surgical treatment were randomized to either a strong opioid group (oxycodone 5 mg or 10 mg four times a day) or a mild opioid group (a combination of acetaminophen and codeine 500 mg and 8 mg, or 1,000 mg and 16 mg, four times a day) for up to three weeks.

From postdischarge day 1 to day 7, the mean score on a scale of 0 to 10, where 0 represents no pain and 10 represents the worst pain imaginable, was 4.04 in the strong opioid group versus 4.54 in the mild opioid group. This difference wasn't statistically significant. There were also no statistically significant differences in adverse effects or other secondary outcomes.

According to the authors, the findings suggest there is no clinically important benefit to using strong rather than mild opioids for postdischarge care of patients who have surgically treated orthopedic fractures. A mild opioid combination of acetaminophen and codeine, they say, may be a viable alternative to the standard practice of prescribing strong opioids for these patients.

The study was conducted in a single center, which may limit generalizability, and fragility fractures among older adults were excluded, so the results don't apply to this population. Also, because patient dropout was allowed after day 7, there is potential bias for findings from days 8 to 21, the authors note.