126 Multimodal Analgesia and Discharge Opioid Requirements in Burn Patients

Abstract

Abstract Introduction Analgesia in burn patients is significantly challenging given the complexity of burn pain. Opioids are a mainstay of therapy, but studies demonstrate varying outcomes with respect to the efficacy of adjunctive non-opioid agents in the treatment of burn pain. The need for analgesia extends beyond hospital admission—given the known risks of opioids, the impact of multimodal analgesia on opioid requirements post-discharge needs to be further elucidated in this population. Methods In this retrospective, single-center cohort study, adult burn patients who were consecutively admitted to the burn ICU service and subsequently followed in the burn clinic between 2/2015 and 9/2018 were evaluated up to 6 months post-discharge. The subjects were divided into two cohorts based on discharge pain regimens: multimodal vs non-multimodal. Individuals taking long-acting opioids prior to admission were excluded. The primary outcome was the change in oral morphine equivalents (OME) between discharge and follow up occurring between 2 - 6 weeks post-discharge. Secondary outcomes included the number of multimodal agents utilized and a comparison of OME between the last 24 hours of admission and discharge. Results A total of 152 patients were included for analysis (n= 76 per cohort). The multimodal cohort demonstrated increased total body surface area burned (23.9% ± 15.4 vs 16.6% ± 7.1; p < 0.001) and prolonged number of days spent in the ICU (22.7 ± 23.1 vs 10.7 ± 8.9; p < 0.001). The change in OME from discharge to first follow up was -106.6 mg in the multimodal vs -75.4 mg in the non-multimodal cohort (p = 0.039; figure 1). In each cohort, discharge OME did not statistically differ from last 24 hour OME (multimodal: p = 0.067; non-multimodal: p = 0.537). The most common non-opioid agents utilized were acetaminophen and gabapentin. Conclusions Despite extended ICU length of stay and larger TBSA, burn patients discharged with multimodal pain regimens demonstrated a statistically significant reduction in oral morphine equivalents from discharge to first follow up compared to those discharged on opioid-only regimens. Applicability of Research to Practice This study demonstrates promising results with respect to lowering discharge opioid requirements by utilizing a multimodal analgesic approach in the management of burn pain.