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Impact of Opioid-Minimizing Pain Protocols After Burn Injury
Journal article   Peer reviewed

Impact of Opioid-Minimizing Pain Protocols After Burn Injury

Deepanjli Donthula, Christopher R Conner, Van Thi Thanh Truong, Charles Green, Chuantao Jiang, Michael W Wandling, Spogmai Komak, Todd F Huzar, Sasha D Adams, Daniel J Freet, …
Journal of burn care & research, Vol.42(6), pp.1146-1151
11/24/2021
DOI: 10.1093/jbcr/irab143
PMCID: PMC8921736
PMID: 34302482
url
https://www.ncbi.nlm.nih.gov/pmc/articles/8921736View
Open Access

Abstract

In 2019, we implemented a pill-based, opioid-minimizing pain protocol and protocolized moderate sedation for dressing changes in order to decrease opioid exposure in burn patients. We hypothesized that these interventions would reduce inpatient opioid exposure without increasing acute pain scores. Two groups of consecutive patients admitted to the burn service were compared: Pre-group (from January 1, 2018 to July 31, 2019) and Post-group (from January 1, 2020 to June 30, 2020) from before and after the implementation of the protocols (from August 1, 2019 to December 31, 2019). We abstracted patient demographics and burn injury characteristics from the burn registry. We obtained opioid exposure and pain scale scores from the electronic medical record. The primary outcome was total morphine milligram equivalents (MMEs). Secondary outcomes included MMEs/day, pain domain-specific MMEs, and pain scores. Pain was estimated by creating a normalized pain score (range 0-1), which incorporated three different pain scales (Numeric Rating Scale, Behavioral Pain Scale, and Behavioral Pain Assessment Scale). Groups were compared using Wilcoxon rank-sum and chi-square tests. Treatment effects were estimated using Bayesian generalized linear models. There were no differences in demographics or burn characteristics between the Pre-group (n = 495) and Post-group (n = 174). The Post-group had significantly lower total MMEs (Post-group 110 MMEs [32, 325] vs Pre-group 230 [60, 840], P < .001), MMEs/day (Post-group 33 MMEs/day [15, 54] vs Pre-group 52 [27, 80], P < .001), and domain-specific total MMEs. No difference in average normalized pain scores was seen. Implementation of opioid-minimizing protocols for acute burn pain was associated with a significant reduction in inpatient opioid exposure without an increase in pain scores.
 Acute Pain - drug therapy Acute Pain - etiology Adult Analgesics, Opioid - therapeutic use Bayes Theorem Burns - complications Burns - drug therapy Drug Prescriptions - statistics & numerical data Female Humans Male Middle Aged Pain Management - statistics & numerical data Practice Patterns, Physicians' - statistics & numerical data Retrospective Studies

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