Implementation of a multi-modal pain regimen to decrease inpatient opioid exposure after injury.

Implementation of a multi-modal pain regimen to decrease inpatient opioid exposure after injury.

Publication date: Dec 01, 2019

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.

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.

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?

Wei, S., Green, C., Truong, V.T.T., Howell, J., Ugarte, S.M., Albarado, R., Taub, E.A., Meyer, D.E., Adams, S.D., McNutt, M.K., Moore, L.J., Cotton, B.A., Kao, L.S., Wade, C.E., Holcomb, J.B., and Harvin, J.A. Implementation of a multi-modal pain regimen to decrease inpatient opioid exposure after injury. 04300. 2019 Am J Surg (218):6.

Concepts Keywords
Bayesian Morphine
Generalized Linear Model Interquartile range
Hospital Naltrexone
Interquartile Range Opioid
IQR Phenols
ISS RTT
Medians Morphinans
Milligram Ethers
MMPR Receptor antagonists
Modal Acute pain
Morphine Chemical compounds
Opioid Pain management
Pain Pain
Rib Fracture
Trauma
Trauma Center

Semantics

Type Source Name
disease MESH multi
drug DRUGBANK Methionine
drug DRUGBANK Morphine
drug DRUGBANK Methylthioinosine
drug DRUGBANK Sulpiride

Original Article

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