817: EFFECT OF GABAPENTIN AND METHOCARBAMOL ON LENGTH OF STAY IN PATIENTS WITH TRAUMATIC RIB FRACTURES

Abstract

Introduction: Use of opioid-sparing agents in patients with traumatic rib fractures is associated with positive outcomes such as reduced intensive care unit (ICU) length of stay (LOS) and opioid exposure. While multiple studies have aimed to evaluate analgesic interventions for rib fractures, no specific bundled combination of analgesia has demonstrated superiority. The objective of this study was to characterize the effect of non-opioid analgesic agents (methocarbamol and gabapentin) as part of a multimodal pain regimen including acetaminophen and lidocaine patches on ICU LOS, hospital LOS, and opioid utilization in patients with traumatic rib fractures. Methods: This was a retrospective cohort study of patients admitted to a surgical ICU at a level I trauma center. Of these, patients with at least one rib fracture were eligible for inclusion. Patients were divided between APAP-lidocaine-methocarbamol and APAP-lidocaine-gabapentin groups. The primary endpoint, ICU LOS, and secondary endpoint of hospital LOS were analyzed by log-rank test. Average cumulative oral morphine equivalents (OME) was analyzed by t-test. Results: 129 patients were included in study analysis: 98 in the APAP-lidocaine-gabapentin group and 31 in the APAP-lidocaine-methocarbamol group. There were no differences in age, sex, race, type of injury, mechanism of injury, and injury severity. The median ICU LOS was similar between APAP-lidocaine-gabapentin (2 +/- 3.2 days) and APAP-lidocaine-methocarbamol (1.8 +/- 1 days) (p=0.23). There was no difference in median hospital LOS between APAP-lidocaine-gabapentin (3.7 +/- 3.8 days) and APAP-lidocaine-methocarbamol (3.8 +/- 1.9 days) (p=0.72). There was also no difference in average cumulative opioid exposure between APAP-lidocaine-gabapentin (85.1 +/- 40.5 mg) and APAP-lidocaine-methocarbamol (84.4 +/- 46.2 mg) (p=0.98). Conclusions: The addition of gabapentin or methocarbamol to acetaminophen plus topical lidocaine patches did not appear to affect the LOS or opioid exposure in this cohort of patients with traumatic rib fractures.