Mitchell Daley, BCCCP, PharmD, FCCM
Clinical Pharmacist Specialist Critical Care
Seton Family Healthcare, University of Texas
Austin, Texas
Disclosure information not submitted.
Emmy Gibbons, PharmD
Clinical Pharmacy Specialist
University Hospital San Antonio, United States
Disclosure information not submitted.
Emily Hodge, PharmD, BCCCP
Clinical Pharmacy Specialist, Critical Care
Ascension Seton, United States
Disclosure information not submitted.
Molly Curran, PharmD, BCCCP, BCPS
Clinical Pharmacy Manager
Ascension Seton, United States
Disclosure information not submitted.
Alan Hao, PharmD
Pharmacy Intern
Dell Seton Medical Center at the University of Texas, United States
Disclosure information not submitted.
Chris Nelsen, PharmD
Pharmacy Intern
Dell Seton Medical Center at the University of Texas, United States
Disclosure information not submitted.
Tatiana Cardenas, MD, MS
Assistant Professor- Dept of Surgery and Perioperative Care/ Division of Acute Care Surgery
University of Texas at Austin Dell Medical School, United States
Disclosure information not submitted.
Marc Trust, MD
Assistant Professor of Surgery and Perioperative Care
Dell Seton Medical Center at the University of Texas, United States
Disclosure information not submitted.
Pedro Teixeira, MD
Associate Professor
University of Texas at Austin Dell Medical School, United States
Disclosure information not submitted.
Jayson Aydelotte, MD
Associate Professor
Dell Seton Medical Center at the University of Texas, United States
Disclosure information not submitted.
Carlos Brown, MD
Professor of Surgery
Dell Seton Medical Center at the University of Texas, United States
Disclosure information not submitted.
Title: Take a Breath in the Opioid Epidemic: Multimodal Pain Protocol for Rib Fractures Reduces Opioids
Introduction: In the United States, almost fifty people die everyday from a prescription opioid overdose, highlighting the need to transform prescribing of both opioid and nonopioid pain medications. The purpose of this study is to evaluate the effectiveness of a multi-modal pain protocol (MMPP) in decreasing opioid requirements amongst trauma patients hospitalized with multiple rib fractures.
Methods: This retrospective, single-center, cohort study enrolled adult trauma patients admitted with multiple ( >/= 3) rib fractures from July 2014 to October 2019. The MMPP protocol was implemented in February 2017, defining the post-MMPP group. Patients were enrolled in reverse, chronological order in the pre-MMPP group. The primary outcome was oral morphine milligram equivalent (OMME) requirements, while secondary outcomes included mortality, ICU and hospital length of stay, and safety outcomes, including endotracheal intubation, pneumonia, naloxone use, delirium, acute kidney injury or gastrointestinal bleeding.
Results: A total of 209 patients were included in each group. The primary outcome of OMME requirements was significantly lower in the post-MMPP (155 vs. 415, p < 0.001), which remained significant in geriatric patients (90 vs. 242, p< 0.001) or had an epidural placed (153vs. 369, p< 0.001). The proportion of delirium positive days was significantly lower in the post-MMPP group (8.6% vs. 22.3%, p=0.003). There was no difference in mortality, length of stay or other safety endpoints.
Conclusions: In trauma patients with multiple orib fractures, implementation of a multimodal pain management protocol reduced opioid requirements and delirium.