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. 2022 Mar 1;92(3):588-596.
doi: 10.1097/TA.0000000000003486.

Multimodal analgesia reduces opioid requirements in trauma patients with rib fractures

Shakira W Burton  1 , Christina Riojas, Gail Gesin, Charlotte B Smith, Vashti Bandy, Ronald Sing, Tamar Roomian, Meghan K Wally, Cynthia W Lauer; PRIMUM Group
Collaborators, Affiliations

Multimodal analgesia reduces opioid requirements in trauma patients with rib fractures

Shakira W Burton et al. J Trauma Acute Care Surg. .

Abstract

Background: Rib fractures are common in trauma patients and are associated with significant morbidity and mortality. Adequate analgesia is essential to avoid the complications associated with rib fractures. Opioids are frequently used for analgesia in these patients. This study compared the effect of a multimodal pain regimen (MMPR) on inpatient opioid use and outpatient opioid prescribing practices in adult trauma patients with rib fractures.

Study design: A pre-post cohort study of adult trauma patients with rib fractures was conducted at a Level I trauma center before (PRE) and after (POST) implementation of an MMPR. Patients on long-acting opioids before admission and those on continuous opioid infusions were excluded. Primary outcomes were oral opioid administration during the first 5 days of hospitalization and opioids prescribed at discharge. Opioid data were converted to morphine milligram equivalents (MMEs).

Results: Six hundred fifty-three patients met inclusion criteria (323 PRE, 330 POST). There was a significant reduction in the daily MME during the second through fifth days of hospitalization; and the average inpatient MME over the first five inpatient days (23 MME PRE vs. 17 MME POST, p = 0.0087). There was a significant reduction in the total outpatient MME prescribed upon discharge (322 MME PRE vs. 225 MME POST, p = 0.006).

Conclusion: The implementation of an MMPR in patients with rib fractures resulted in significant reduction in inpatient opioid consumption and was associated with a reduction in the quantity of opiates prescribed at discharge.

Level of evidence: Therapeutic/Care Management; level IV.

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Conflict of interest statement

Conflicts of Interest

Michael Bosse reports stock ownership in an orthopaedic implant company and a grand from the DOD. Christopher Griggs reports American College of Emergency Physicians board membership and payment from Boston University for preparation of pain management and opioid prescribing. Daniel Leas reports consultancy for Restor3d and ownership in Pressio. Joseph R. Hsu reports consultancy for Globus Medical and personal fees from Smith & Nephew speakers’ bureau. Michael Runyon reports research funding from Abbott Laboratories and Bristol-Myers Squibb. All other authors have nothing to declare.

Figures

Figure 1.
Figure 1.
Revised MMPR Orderset
Figure 2.
Figure 2.
Control Charts for percent of patients receiving a gabapentinoid (a), average MME (b), and percent of patients prescribed an opioid at discharge (c) Rules for special cause variation include: 1) 1 point outside 3 sigma limit; 2) 6 consecutive points increasing or decreasing; 3) 8 or more consecutive points above or below centerline; 4) 2 out of 3 points in outer third; 5) Hugging – 15 points in inner third. Special cause variation is shown in red.
Figure 2.
Figure 2.
Control Charts for percent of patients receiving a gabapentinoid (a), average MME (b), and percent of patients prescribed an opioid at discharge (c) Rules for special cause variation include: 1) 1 point outside 3 sigma limit; 2) 6 consecutive points increasing or decreasing; 3) 8 or more consecutive points above or below centerline; 4) 2 out of 3 points in outer third; 5) Hugging – 15 points in inner third. Special cause variation is shown in red.
See this image and copyright information in PMC

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