Justin Culshaw, PharmD,
PGY2 Critical Care Pharmacy Resident
University of Cincinnati Medical Center
Cincinnati, Ohio
Disclosure information not submitted.
Carolyn Philpott, PharmD, BCCCP
Clinical Pharmacy Specialist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Krissy Reinstatler, PharmD, BCPP, MBA
Clinical Pharmacist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Paige Bradshaw, BCCCP, PharmD
Clinical Pharmacy Specialist - Critical Care/Emergency Medicine
University of Cincinnati Medical Center
Mason, Ohio
Disclosure information not submitted.
Marisa Brizzi, PharmD, BCPS, AAHIVP
Clinical Pharmacist
University of Cincinnati Medical Center, United States
Disclosure information not submitted.
Amy Makley, MD, FACS
Associate Professor of Surgery
University of Cincinnati College of Medicine, United States
Disclosure information not submitted.
Molly Droege, PharmD
Clinical Pharmacy Specialist
UC Health/University of Cincinnati Medical Center
Cincinnati, Ohio, United States
Disclosure information not submitted.
Title: Evaluation of Acute Pain Management in Trauma Patients on Home Buprenorphine
Introduction: Clinical controversy surrounds acute pain management in patients receiving buprenorphine for opioid replacement therapy prior to hospitalization. A paucity of data exists describing the clinical impact of continuing versus stopping buprenorphine, and expert opinion currently drives inpatient analgesia strategies. This study evaluated acute pain management in trauma patients prescribed buprenorphine prior to admission.
Methods: This was a retrospective, single center cohort study of adult trauma patients admitted to an urban, academic, level-1 trauma center between January 1, 2017 and August 1, 2020. Patients admitted to the trauma or orthopedics service following acute injury were included if they had a length of stay of ≥24 hours and were prescribed and adherent to buprenorphine prior to admission. Adherence was confirmed by documented positive toxicology screen at time of admission or explicit documentation. Patients were stratified into two groups: buprenorphine discontinued (BD) or continued (BC) during hospitalization. BC was defined as buprenorphine administered for at least 50% of hospital length of stay. The primary outcome was the comparison of average daily milligram morphine equivalents (MME) between groups. Secondary outcomes included comparison of Numeric Rating Scale (NRS) scores proportion of severe pain defined as NRS of 7-10.
Results: A total of 57 patients were included: 37 (64.9%) BD and 20 (35.1%) BC. 35 (61.4%) patients were admitted to the trauma service with a median injury severity score of 10 [IQR 9-18] for BD and 14 [IQR 8.25-22] for BC (p=0.5). Home buprenorphine daily dose was similar at 8 [IQR 8-16] mg for BD and 16 [IQR 8-16] mg for BC (p=0.25). Average daily MME was higher in BD than BC (103.7 [IQR 80.7 – 166] versus 67 [IQR 30.8 – 97.4], p=0.002). Proportion of severe pain for BD and BC was similar at 67.2% and 70.2%, respectively (p=0.19).
Conclusions: Buprenorphine continuation during hospitalization reduced opioid consumption without negative impact on patient-reported pain scores following acute injuries. Larger studies are needed to further describe the impact of home buprenorphine continuation in trauma patients with acute pain.