Implementation of Multimodal Pain Protocol Associated With Opioid Use Reduction in Trauma Patients

• Published in: The Journal of surgical research Vol. 284; pp. 114 - 123
• Main Authors: Sparks Joplin, Tasha, Bhatia, Manisha B., Robbins, Christopher B., Morocho, Catherin D., Chiang, Jessica C., Murphy, Patrick B., Miller, Emily M., Meagher, Ashley D., Padilla-Jones, Brandy B.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.04.2023
• Subjects: Adult; Aged; Analgesics, Non-Narcotic - therapeutic use; Analgesics, Opioid - therapeutic use; Female; Humans; Male; Middle Aged; Morphine Derivatives - therapeutic use; Multimodal; Nonopioids; Opioid-Related Disorders; Opioids; Pain; Pain, Postoperative - drug therapy; Retrospective Studies; Trauma; Nonopioids; Multimodal; Trauma; Opioids
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2022.10.052

Many trauma centers have adopted multimodal pain protocols (MMPPs) to provide safe and effective pain control. The objective was to evaluate the association of a protocol on opioid use in trauma patients and patient-reported pain scores. This was a retrospective review of adult trauma patients admitted from 7/1-9/30/2018 to 7/1-9/30/2019 at an urban academic level 1 trauma center. The MMPP consisted of scheduled nonopioid medications implemented on July 1, 2019. Patients were stratified by level of care upon admission, intensive care unit (ICU) or floor, and by injury severity score (ISS) (ISS < 16 or ISS ≥ 16). Pain scores, opioid, and nonopioid analgesic medication use were compared for the hospital stay or first 30 d. Seven hundred ninety eight patients were included with a mean age of 54 ± 22 y and 511 (64.0%) were men. Demographic and clinical characteristics between those in the pre-MMP (n = 404) and post-MMPP (n = 394) groups were not different. The average pain scores were not different between the two groups (3.7 versus 3.8, P = 0.44), but patients in the post-MMPP group received 36% less morphine milliequivalents (109.6 versus 70; P < 0.0001). The MMPP had the largest effect on patients admitted to the ICU regardless of injury severity. ICU patients with ISS ≥ 16 had the greatest reduction in morphine milliequivalents (174.6 versus 84.4; P < 0.0001). The use of nonopioid analgesics was significantly increased in all groups. A MMPP is associated with a reduction of opioids and increase in nonopioid analgesics with no difference in patient-reported pain scores. •Use of MMPPs correlate with a reduction in opioid use.•MMPPs are associated with no change in pain scores.•MMPPs in ICU patients have a significant correlation of reduced opioid use.