USA Health, Department of Surgery, Division of Trauma, Acute Care Surgery & Burns, Mobile, AL, USA.
College of Pharmacy, University of Florida, Gainesville, FL, USA.
Am Surg. 2023 Nov;89(11):4281-4287. doi: 10.1177/00031348221101483. Epub 2022 May 27.
Opioids remain the mainstay treatment of acute pain caused by trauma. The lack of evidence driven prescribing creates a challenging situation for providers. We hypothesized that the implementation of a trauma discharge opioid bundle (TDOB) would decrease the total morphine milligram equivalents (MME) prescribed at discharge while maintaining pain control.
This was a pre-post study of adult trauma patients before and after implementation of a TDOB to guide the prescription of opioids and discharge prescription education in patients discharged from a level one trauma center. The pre-group and post-group, included consecutively discharged patients from September through November in 2018 and 2019. The primary outcome was the total MME prescribed at discharge.
A total of 377 patients met inclusion criteria. One hundred and fifty-one patients were included in the pre-group and 226 in the post-group. The total MME prescribed at discharge (225 ± [150-300] pre vs 200 ± [100-225] post, P = < .001) and maximum MME/day (45 ± [30-45] vs 30 ± [20-45], P = .004) were significantly less in the post-group. Incidence of outpatient refills within fourteen days were similar. More non-opioid pain adjuncts were prescribed post-intervention and discharge pain education was provided more frequently.
The implementation of a TDOB significantly reduced the MME prescribed at discharge without increasing the number of opioid refills.
阿片类药物仍然是创伤引起的急性疼痛的主要治疗方法。缺乏循证指导的处方制定给医务人员带来了挑战。我们假设实施创伤出院阿片类药物包（TDOB）将减少出院时开具的吗啡毫克当量（MME）总量，同时保持疼痛控制。
这是一项在实施 TDOB 前后对成人创伤患者进行的前后研究，旨在指导一级创伤中心出院患者的阿片类药物处方和出院处方教育。预组和后组分别包括 2018 年 9 月至 11 月和 2019 年同期连续出院的患者。主要结局是出院时开具的总 MME。
共有 377 名患者符合纳入标准。151 名患者纳入预组，226 名患者纳入后组。出院时开具的总 MME（225±[150-300] vs 200±[100-225]，P <.001）和最大 MME/天（45±[30-45] vs 30±[20-45]，P =.004）在后组显著减少。14 天内门诊随访的发生率相似。干预后开具的非阿片类药物辅助止痛药更多，且更频繁地提供出院疼痛教育。
实施 TDOB 可显著减少出院时开具的 MME 总量，而不会增加阿片类药物的随访次数。
