Perioperative Multimodal Pain Management Approach in Older Adults With Polytrauma

被引:7
|
作者
Shafeeq, Hira [1 ,2 ]
DiGiacomo, Jody C. [2 ]
Sookraj, Kelley A. [2 ]
Gerber, Noam [2 ]
Bahr, Alaa [3 ]
Talreja, Om N. [4 ]
Munnangi, Swapna [2 ]
Cardozo-Stolberg, Sarah [2 ]
Angus, L. D. George [2 ]
机构
[1] St Johns Univ, Coll Pharm & Hlth Sci, Clin Hlth Profess, Queens, NY USA
[2] Nassau Univ Med Ctr, Dept Surg, East Meadow, NY USA
[3] Lincoln Med Ctr, Dept Pharm, Bronx, NY USA
[4] Metropolitan Hosp Ctr, Dept Pharm, New York, NY 10029 USA
关键词
Pain; Perioperative; Analgesia; Acetaminophen; Opioids; ORAL ACETAMINOPHEN; AMERICAN-SOCIETY; COSTS; ANALGESICS;
D O I
10.1016/j.jss.2021.12.028
中图分类号
R61 [外科手术学];
学科分类号
摘要
Introduction: 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.Materials and methods: This was a retrospective, single-center, observational cohort study of polytrauma, orthopedic surgical patients aged >50 y. Patients admitted in 2017, post implementation 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. Results: 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 48 h postoperatively (20.9 +/- 27 versus 4.3 +/- 12.4 MME [P < 0.05] at 24 h and 19.8 +/- 31.2 versus 2.1 +/- 11.3 MME [P < 0.05] at 48 h, respectively). The mean opioid consumption remained significantly lower in patient subgroup of age >74 y with no difference in the mean pain scores (1.5 +/- 1.5 versus 1.9 +/- 1.6 [P = 0.48] at 24 h and 1.5 +/- 1.8 versus 2.0 +/- 1.5 [P = 0.21] at 48 h 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). Conclusions: 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. (c) 2022 Elsevier Inc. All rights reserved.
引用
收藏
页码:96 / 102
页数:7
相关论文
共 50 条
  • [41] Cancer Pain Management Considerations in Older Adults
    Cope, Diane G.
    SEMINARS IN ONCOLOGY NURSING, 2019, 35 (03) : 274 - 278
  • [42] Pain management in older adults: facts to consider
    Paul, Alok K.
    Lewis, Richard J.
    PAIN, 2022, 163 (03) : E497 - +
  • [43] Perioperative Pain Management for Elective Spine Surgery: Opioid Use and Multimodal Strategies
    Corley, Jacquelyn A.
    Charalambous, Lefko T.
    Mehta, Vikram A.
    Wang, Timothy Y.
    Abdelgadir, Jihad
    Than, Khoi D.
    Abd-El-Barr, Muhammad M.
    Goodwin, C. Rory
    Shaffrey, Christopher, I
    Karikari, Isaac O.
    WORLD NEUROSURGERY, 2022, 162 : 118 - +
  • [44] Multimodal Approach to Pain Management: Layering for Safety and Efficacy
    Epstein, M. E.
    ISRAEL JOURNAL OF VETERINARY MEDICINE, 2011, 66 (02): : 3 - 11
  • [45] Post cesarean delivery pain management: multimodal approach
    Pan, Peter H.
    INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 2006, 15 (03) : 185 - 188
  • [46] Post caesarean delivery pain management: multimodal approach
    Faboya, A.
    Uncles, D.
    INTERNATIONAL JOURNAL OF OBSTETRIC ANESTHESIA, 2007, 16 (02) : 185 - 186
  • [47] Perioperative care in older adults
    Baquero, Giselle A.
    Rich, Michael W.
    JOURNAL OF GERIATRIC CARDIOLOGY, 2015, 12 (05) : 465 - 469
  • [48] Perioperative care in older adults
    Giselle A Baquero
    Michael W Rich
    Journal of Geriatric Cardiology, 2015, 12 (05) : 465 - 469
  • [49] Pain management in older adults: facts to consider Reply
    Kwekkeboom, Kristine L.
    Serlin, Ronald C.
    Ward, Sandra E.
    LeBlanc, Thomas W.
    Ogunseitan, Adeboye
    Cleary, James
    PAIN, 2022, 163 (03) : E499 - E499
  • [50] Chronic pain management for older adults in ambulatory care
    Koios, Daniela
    Wenzel, Arlett
    Kuhnert, Ronny
    Rank, Christina
    Riemer, Thomas Gunther
    Glawe, Magdalena
    Kreutz, Reinhold
    Draeger, Dagmar
    ZEITSCHRIFT FUR GERONTOLOGIE UND GERIATRIE, 2025, 58 (02): : 129 - 136