Singer Kathleen E, Philpott Carolyn D, Bercz Aron P, Phillips Tabatha, Salyer Christen E, Hanseman Dennis, Droege Molly E, Goodman Michael D, Makley Amy T
Department of General Surgery, University of Cincinnati, Cincinnati, Ohio.
Department of Pharmacology, University of Cincinnati, Cincinnati, Ohio.
J Surg Res. 2021 Dec;268:9-16. doi: 10.1016/j.jss.2021.05.052. Epub 2021 Jul 23.
Multimodal analgesia protocols have been implemented after elective surgery to reduce opioid use, however there is limited data on utility after polytrauma. Therefore, we investigated the impact of a multimodal analgesia protocol on inpatient and post-discharge outpatient opioid use after polytrauma.
A retrospective review of patients admitted to a Level I trauma center between September 2017-February 2018 (prior to multimodal protocol; "pre-cohort") and October 2018-April 2019 (after multimodal protocol; "post-cohort") was performed. An outpatient controlled substance registry was utilized to capture morphine milligram equivalents (MME) and gabapentin dispensed in the 6 mo after injury.
620 patients were included (295 pre-cohort, 325 post-cohort). Total inpatient MME decreased from 177.5 mg-130 mg (P= 0.01) between the cohorts. Daily inpatient MME decreased from 70.8 mg-44.7 mg (P< 0.01). Intravenous hydromorphone decreased from 2 mg in the pre-cohort to 1 mg in the post-cohort (P= 0.02). Inpatient oxycodone decreased from 45 mg-30 mg (P= 0.01). Concurrently, gabapentin increased from 0 mg-400 mg in the post-cohort (P< 0.01). Patients in the post-cohort were prescribed fewer MMEs than the pre-cohort at discharge (P< 0.05). However, the number of patients prescribed gabapentin increased from 6.1%-16% (P< 0.01).
Implementation of an updated multimodal analgesia protocol decreased total MME, daily MME, hydromorphone, and oxycodone consumed while increasing gabapentin use. This suggests that while reducing opioid usage in-hospital is critical to reducing outpatient usage, multimodal pain protocols may lead to an increase in gabapentin prescriptions and utilization after discharge.
择期手术后已实施多模式镇痛方案以减少阿片类药物的使用，然而关于多发伤后该方案效用的数据有限。因此，我们研究了多模式镇痛方案对多发伤患者住院期间及出院后门诊阿片类药物使用的影响。
对2017年9月至2018年2月（多模式方案实施前；“前队列”）和2018年10月至2019年4月（多模式方案实施后；“后队列”）入住一级创伤中心的患者进行回顾性研究。利用门诊管制药品登记系统获取受伤后6个月内发放的吗啡毫克当量（MME）和加巴喷丁的量。
共纳入620例患者（前队列295例，后队列325例）。两队列间住院期间总MME从177.5毫克降至130毫克（P = 0.01）。住院期间每日MME从70.8毫克降至44.7毫克（P < 0.01）。静脉注射氢吗啡酮从前队列的2毫克降至后队列的1毫克（P = 0.02）。住院期间羟考酮从45毫克降至30毫克（P = 0.01）。同时，后队列中加巴喷丁从0毫克增至400毫克（P < 0.01）。后队列患者出院时开具的MME比前队列少（P < 0.05）。然而，开具加巴喷丁的患者数量从6.1%增至16%（P < 0.01）。
实施更新的多模式镇痛方案可降低总MME、每日MME、氢吗啡酮和羟考酮的消耗量，同时增加加巴喷丁的使用量。这表明虽然减少住院期间阿片类药物的使用对于减少门诊使用至关重要，但多模式疼痛方案可能导致出院后加巴喷丁处方和使用量增加。
