Perioperative Multimodal Pain Management Approach in Older Adults With Polytrauma.

Abstract

The use of intravenous (IV) acetaminophen (APAP) postoperatively in older adults may be a beneficial strategy. We implemented a multimodal pain management approach in our hospital in 2015, with IV APAP being the first-line therapy. This was a retrospective, single-center, observational cohort study of polytrauma, orthopedic surgical patients aged ≥50y. Patients admitted in 2017, postimplementation of pain protocol, were categorized as the exposed patients. Patients in the year 2014 served as the historical cohort. The two primary outcomes evaluated were postoperative opioid consumption in morphine milligram equivalents (MMEs) and patient pain scores. In total, 121 eligible patients were identified for this study; 22 historical control patients and 99 exposed patients. We observed a significant reduction in postoperative opioid use up to 48h postoperatively (20.9±27 versus 4.3±12.4 MME [P<0.05] at 24h and 19.8±31.2 versus 2.1±11.3 MME [P<0.05] at 48h, respectively). The mean opioid consumption remained significantly lower in patient subgroup of age ≥74y with no difference in the mean pain scores (1.5±1.5 versus 1.9±1.6 [P=0.48] at 24h and 1.5±1.8 versus 2.0±1.5 [P=0.21] at 48h postoperatively in the historical versus exposed cohort, respectively). Exposed patients had a shorter hospital length of stay than control patients (5.0 [3, 7] versus 6.5 [5, 9.5] d; P=0.01). The use of multimodal pain management with IV APAP as first-line therapy was associated with reduced opioid use in the perioperative setting for older adults with polytrauma.