Multi-Modal Analgesic Strategy for Trauma: A Pragmatic Randomized Clinical Trial

Area of Science:

• Trauma surgery
• Pain management
• Pharmacology

Background:

• Effective strategies are needed to manage acute pain and reduce opioid exposure in injured patients.
• Multimodal pain regimens (MMPRs) are a key approach in trauma care.
• Urban trauma centers face challenges in optimizing pain management protocols.

Purpose of the Study:

• To compare two MMPRs for their effectiveness in minimizing opioid exposure and relieving acute pain.
• To evaluate the impact of a generic medication-based MMPR on opioid use in trauma patients.
• To assess pain scores and opioid prescribing patterns in trauma admissions.

Main Methods:

• An unblinded, pragmatic, randomized comparative effectiveness trial was conducted.
• Adult trauma admissions were randomized to either the original MMPR or the Multi-Modal Analgesic Strategies for Trauma (MAST) MMPR.
• Primary endpoint was oral morphine milligram equivalents (MMEs) per day; secondary outcomes included total MMEs, discharge opioid prescriptions, and pain scores.

Main Results:

• The MAST MMPR resulted in significantly lower MMEs per day (34 vs. 48 MMEs/d; p < 0.001).
• Fewer patients receiving the MAST MMPR were prescribed opioids at discharge (62% vs. 67%; p = 0.029).
• No clinically significant differences in pain scores were observed between the two groups.

Conclusions:

• The MAST MMPR is a generalizable and accessible approach for reducing opioid exposure post-trauma.
• This generic medication-based regimen effectively controls acute pain in trauma patients.
• The findings support the adoption of the MAST MMPR in busy urban trauma centers.