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Published on: April 14, 2016
Implementation of a multi-modal pain regimen to decrease inpatient opioid exposure after injury
Shuyan Wei1, Charles Green2, Van Thi Thanh Truong2
1Center for Translational Injury Research, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA; Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, TX, USA; Center for Surgical Trials and Evidence-based Practice, USA.
Introduction:
In 2013, we implemented a pill-based, multi-modal pain regimen (MMPR) in order to decrease in-hospital opioid exposure after injury at our trauma center. We hypothesized that the MMPR would decrease inpatient oral morphine milligram equivalents (MME), decrease opioid prescriptions at discharge, and result in similar Numerical Rating Scale (NRS) pain scores.
Methods:
Adult patients admitted to a level-1 trauma center with ≥1 rib fracture from 2010 to 2017 were included - spanning 3 years before and 4 years after MMPR implementation. MME were summarized as medians and interquartile range (IQR) by year of admission. The effect of the MMPR on daily total MME was estimated using Bayesian generalized linear model.
Results:
Over the 8 year study period, 6,933 patients who met study inclusion criteria were included. No significant differences between years were observed in Abbreviated Injury Scale (AIS) Chest or Injury Severity Scores (ISS). After introduction of the MMPR, there was a significant reduction in median total MME administered per patient day from 60 MME/patient day (IQR 36-91 MME/patient day) pre-MMPR implementation to 37 MME/patient day (IQR 18-61 MME/patient day) in 2017, p < 0.01. Total MME administered per patient day decreased by 31% in 2017 as compared to 2010 (rate ratio 0.69, 95% CI 0.64-0.75). Average NRS pain scores decreased by 0.8 points (95% CI -0.87, -0.81) from 2010 to 2017.
Conclusion:
The introduction of a multi-modal pain regimen resulted in significant reduction in in-patient opioid exposure after injury. The reduction in inpatient opioid use from 2010 to 2017 was equivalent to 11 mg less oxycodone or 17 mg less hydrocodone per patient per day. Additionally, use of the MMPR was associated with a reduction in NRS pain scores.
Insights
A multi-modal pain regimen (MMPR) significantly reduced inpatient opioid exposure in trauma patients. This approach lowered opioid administration and improved pain scores, offering a safer alternative for managing pain after injury.
Area of Science:
- Trauma surgery
- Pain management
- Pharmacology
Background:
- Opioid overreliance is a significant concern in trauma care.
- Multi-modal pain regimens aim to reduce opioid consumption.
- Implementing new pain management strategies is crucial for patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a multi-modal pain regimen (MMPR) in reducing in-hospital opioid exposure.
- To assess the impact of MMPR on opioid prescriptions at discharge.
- To determine if MMPR affects patient-reported pain scores (Numerical Rating Scale - NRS).
Main Methods:
- Adult patients with rib fractures at a level-1 trauma center were studied from 2010-2017.
- Data included opioid administration (MME) and NRS pain scores.
- Bayesian generalized linear models analyzed the effect of MMPR on daily MME.
Main Results:
- A significant reduction in median MME per patient day was observed post-MMPR implementation (37 MME vs. 60 MME).
- Total MME decreased by 31% in 2017 compared to 2010.
- Average NRS pain scores decreased by 0.8 points.
Conclusions:
- The MMPR effectively reduced inpatient opioid exposure in trauma patients.
- Opioid use reduction was equivalent to 11 mg less oxycodone or 17 mg less hydrocodone per patient daily.
- MMPR was associated with improved pain control, indicated by lower NRS scores.
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