Comparing Opioid Usage in Non-Intensive Care Unit Trauma Patients After Implementing Multimodal Analgesia Order Sets

Abstract

Opioid addiction frequently occurs after exposure to prescribed pain medications. Trauma patients are likely to receive opioids due to injuries and surgeries resulting in high levels of pain. Multimodal analgesia has been shown to decrease opioid consumption postoperatively. A multimodal analgesia order set was implemented with the goal of increasing prescription of multimodal analgesia contributing to decreased overall opioid use. We hypothesized that the multimodal order set would be associated with significantly less opioid utilization without affecting pain scores. This single-center retrospective cohort analysis included non-intensive care unit trauma patients. Patients were propensity-matched by the year of treatment. Oral morphine equivalents and pain scores were compared before and after implementation of the order set. The primary objective was to evaluate differences in oral morphine equivalents 24h prior to discharge before and after implementation of the multimodal analgesia order sets. One hundred and fourteen patients in the preimplementation group and 121 patients in the postimplementation group met inclusion criteria. Oral morphine equivalents did not differ significantly between the cohorts, 21.3 [0-53.5] OME in 2018 versus 18.8 [0-56.3] in 2020 (P=0.85). Pain scores 24h prior to discharge, 6 [4-8] versus 5.7 [3.5-7] (P=0.4), did not differ significantly between groups despite more operations in the 2020 cohort. Implementation of a multimodal order set was not associated with significant reduction in the amount of opioids used in non-intensive care unit trauma patients. However, pain scores were unchanged despite an increased number of procedures performed suggesting that multimodal analgesia sets may be a useful tool to aid in decreasing opioid utilization after traumatic injuries.