Multimodal approach reduces opioid use in critically ill trauma patients

  • Hamrick KL & al.
  • J Am Coll Surg
  • 20 Feb 2019

  • curated by Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • A multimodal analgesia pain management program that combined opioid and nonopioid agents significantly reduced the overall opioid dose received by critically ill trauma patients without compromising patient comfort.

Why this matters

  • Multimodal analgesia has shown positive results in other patient populations, but had not been studied in critically ill trauma patients.

Study design

  • This retrospective pre-post cohort study evaluated critically injured patients with trauma who were admitted to the intensive care unit pre- (n=65) and postimplementation (n=62) of a multimodal pain management order set.
  • Funding: None disclosed.

Key results

  • Cumulative oral morphine equivalent (OME) dose was significantly lower in the postgroup (125.6 mg; interquartile range [IQR], 45.0-415.0 mg) vs pregroup (481.5 mg; IQR, 174.8-881.3 mg; P<.001>
  • Patients receiving ≥3 multimodal agents had a lower cumulative OME dose (116.3 mg; IQR, 52.5-496.5 mg) vs those who were receiving 1-2 (363 mg; IQR, 115.5-743 mg) or 0 (479 mg; IQR, 185-736.5 mg; P=.024) multimodal agents.
  • Mean pain score on hospital day 5 (4.48±0.34 vs 3.50±0.38; P=.058) or at hospital discharge (3.43±0.34 vs 3.56±0.32; P=.789) was not different between pre- and postgroup.

Limitations

  • Single-center study.
  • Data on long-term opioid use not included.

 Coauthored with Antara Ghosh, PhD