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Singer KE, Philpott CD, Bercz AP, et al. Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma. J Surg Res. 2021;268:9-16doi: 10.1016/j.jss.2021.05.052.
Singer, K. E., Philpott, C. D., Bercz, A. P., Phillips, T., Salyer, C. E., Hanseman, D., Droege, M. E., Goodman, M. D., & Makley, A. T. (2021). Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma. The Journal of surgical research, 2689-16. https://doi.org/10.1016/j.jss.2021.05.052
Singer, Kathleen E, et al. "Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma." The Journal of surgical research vol. 268 (2021): 9-16. doi: https://doi.org/10.1016/j.jss.2021.05.052
Singer KE, Philpott CD, Bercz AP, Phillips T, Salyer CE, Hanseman D, Droege ME, Goodman MD, Makley AT. Impact of a Multimodal Analgesia Protocol on Inpatient and Outpatient Opioid Use in Acute Trauma. J Surg Res. 2021 Jul 16;268:9-16. doi: 10.1016/j.jss.2021.05.052. Epub 2021 Jul 16. PMID: 34280664.
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J Surg Res. 2021 Jul 16;268:9-16. doi: 10.1016/j.jss.2021.05.052. Epub 2021 Jul 16.

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

The Journal of surgical research

Kathleen E Singer, Carolyn D Philpott, Aron P Bercz, Tabatha Phillips, Christen E Salyer, Dennis Hanseman, Molly E Droege, Michael D Goodman, Amy T Makley

Affiliations

  1. Department of General Surgery, University of Cincinnati, Cincinnati, Ohio. Electronic address: [email protected].
  2. Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio.
  3. Department of General Surgery, University of Cincinnati, Cincinnati, Ohio.

PMID: 34280664 DOI: 10.1016/j.jss.2021.05.052

Abstract

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.

Keywords: Multimodal analgesia; Protocol, Opioid; Trauma

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