864 Perioperative Multimodal Analgesia Reduces Opioid Use Following Skin Grafting in Burn Patients

Abstract

Abstract Introduction Burn injuries cause severe pain and patients often require high doses of opioid medications. Pain management is particularly challenging during dressing changes and following skin grafting procedures. Non-opioid analgesic medications and multimodal analgesic strategies have been promoted to improve pain management and decrease opioid use. Methods We performed a retrospective chart review to identify burn patients who underwent autologous skin grafting procedures between January 2011 and June 2018. We included patients who underwent were 18–80 years old and were inpatients for at least 24 hours before and after their procedure. We excluded patients who remained intubated in PACU, had surgery the day prior or had active opioid prescriptions prior to their hospitalization. We evaluated the effect of different non-opioid analgesic medications on opioid use following a skin grafting procedure. The primary outcome measure of this study compared opioid use 24 hours before skin grafting to 24 hours after skin grafting. Results We found that most patients (69%) reported severe pain (NRS ≥7) immediately after autologous skin grafting. On average, patients required an additional 54 mg of oral morphine equivalents (ME) in the 24 hours after the procedure compared to the 24 hours before. The use of perioperative non-opioid analgesia varied between patients (Acetaminophen 29%, gabapentin 29%, ketamine 33% and all three 8%). Patients who received either gabapentin or a combination of acetaminophen, gabapentin and ketamine had a smaller increase in their opioid use than patients who did not receive the medications (-24 ME, CI -46, -3 and -40 ME, CI -75, -5 respectively). Conclusions Burn patients who received perioperative acetaminophen, gabapentin and ketamine required relatively less opioid following their skin grafting procedure. Applicability of Research to Practice These results support the use of multimodal analgesia for perioperative analgesia in burn patients.