Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma.

Autor: Singer KE; Department of General Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: singerke@ucmail.uc.edu., Philpott CD; Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio., Bercz AP; Department of General Surgery, University of Cincinnati, Cincinnati, Ohio., Phillips T; Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio., Salyer CE; Department of General Surgery, University of Cincinnati, Cincinnati, Ohio., Hanseman D; Department of General Surgery, University of Cincinnati, Cincinnati, Ohio., Droege ME; Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio., Goodman MD; Department of General Surgery, University of Cincinnati, Cincinnati, Ohio., Makley AT; Department of General Surgery, University of Cincinnati, Cincinnati, Ohio.
Jazyk: angličtina
Zdroj: The Journal of surgical research [J Surg Res] 2021 Dec; Vol. 268, pp. 9-16. Date of Electronic Publication: 2021 Jul 23.
DOI: 10.1016/j.jss.2021.05.052
Abstrakt: Background: Multimodal analgesia protocols have been implemented after elective surgery to reduce opioid use, however there is limited data on utility after polytrauma. Therefore, we investigated the impact of a multimodal analgesia protocol on inpatient and post-discharge outpatient opioid use after polytrauma.
Methods: A retrospective review of patients admitted to a Level I trauma center between September 2017-February 2018 (prior to multimodal protocol; "pre-cohort") and October 2018-April 2019 (after multimodal protocol; "post-cohort") was performed. An outpatient controlled substance registry was utilized to capture morphine milligram equivalents (MME) and gabapentin dispensed in the 6 mo after injury.
Results: 620 patients were included (295 pre-cohort, 325 post-cohort). Total inpatient MME decreased from 177.5 mg-130 mg (P= 0.01) between the cohorts. Daily inpatient MME decreased from 70.8 mg-44.7 mg (P< 0.01). Intravenous hydromorphone decreased from 2 mg in the pre-cohort to 1 mg in the post-cohort (P= 0.02). Inpatient oxycodone decreased from 45 mg-30 mg (P= 0.01). Concurrently, gabapentin increased from 0 mg-400 mg in the post-cohort (P< 0.01). Patients in the post-cohort were prescribed fewer MMEs than the pre-cohort at discharge (P< 0.05). However, the number of patients prescribed gabapentin increased from 6.1%-16% (P< 0.01).
Conclusion: Implementation of an updated multimodal analgesia protocol decreased total MME, daily MME, hydromorphone, and oxycodone consumed while increasing gabapentin use. This suggests that while reducing opioid usage in-hospital is critical to reducing outpatient usage, multimodal pain protocols may lead to an increase in gabapentin prescriptions and utilization after discharge.
(Copyright © 2021 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE