Implementation of a multimodal pain protocol in adult burn patients

Abstract

The 2020 American Burn Association guidelines recommend a multimodal approach to pain management comprised of both opioids and non-opioids. The purpose of this study was to compare outcomes before and after implementation of a multimodal pain order set in the burn admission order set within the electronic medical record. This single center, retrospective, cohort study was conducted at an American Burn Association-verified burn center. The pre-group (n = 64) and post-group (n = 63) were well-matched with respect to all baseline demographics, such as total body surface area, length of stay, mechanical ventilation, and number of procedures. The primary outcome was daily morphine milligram equivalents received cumulatively through admission day seven. There was a significant reduction in cumulative median morphine milligram equivalents received in the post-group compared to the pre-group (172 versus 97, p = 0.042) without worsening evidence of pain. Doses of scheduled acetaminophen (62.5 % versus 95.2 %, p < 0.001), ibuprofen (31.3 % versus 42.9 %, p = 0.017), and ketamine (14.1 % versus 28.6 %, p = 0.043) were significantly increased in the post-group. Multimodal order set integration significantly improved guideline recommended multimodal analgesic use and is one effective method to increase non-opioid analgesic use for acute pain following a burn injury.

Keywords: Acute Pain; Burns; Multimodal Pain.