861 Analgesia After Burns: A Case Series and Development of a Multimodal Analgesic Enhanced Recovery Pathway

Abstract

Abstract Introduction Burn pain is grossly undertreated which may result in poorer outcomes including chronic pain, anxiety and persistent opioid use. Opioids are currently the mainstay of treatment with many burn patients receiving long term opioid management even in the context of the opioid crisis. We retrospectively reviewed the charts of burn patients admitted to our hospital to evaluate the impact of our multimodal pain management approach on overall opioid consumption. Methods Following IRB approval, a retrospective chart review of all patients with burn injuries over a one year period was performed. The Acute Pain Management Service was consulted for analgesic management for all patients. Patient data was collected from their electronic medical records on Epic HyperSpace and included total body surface area of burn, age and gender, length of hospital stay, amount of opioid usage throughout admission, average verbal numerical score for pain, and use of adjuvant analgesics was gathered. The amount of opioid usage was obtained from the chart and then converted to oral morphine equivalents (OME) using the CDC Prevention Conversion Chart. Results During the study period, eight patients met inclusion criteria. The average patient age was 42.5 years, with a mean of 26.8 % TBSA (Total body surface area) burn and mean length of stay of 23 days. Our pain pathway consisted of non-opioid analgesic adjuncts that were given around-the-clock with opioids used only on an as-needed basis. The nonopioid analgesics include acetaminophen, nonsteroidal anti-inflammatory drugs (NSAIDS), gabapentin or pregabalin, and a ketamine infusion. Initial opioid consumption (on day of APMS consult) as well as median hospital day was compared to opioid consumption on day of discharge. Six out of eight patients showed a reduction in their oral morphine equivalent (OME) following APMS consult usage from day of admission with average 76 OME to 44.6 OME on day of discharge. Conclusions We were able to reduce patient’s opioid requirement in 6 out of 8 patients upon discharge. These findings suggest that a further more rigorous study is warranted to demonstrate the benefits of multimodal therapy in burn pain. Applicability of Research to Practice The multimodal approach to pain control for burn patients may possibly be able to reduce the overall opioid requirements and theoretically the opioid associated side effects.