Multi-modal Pain Control Protocol Decreases Narcotic Consumption in an Inpatient Trauma Population.

INTRODUCTION: Opioid use after surgery or trauma has been implicated as a contributing factor to opioid dependence. The Acute Care Surgery (ACS) service at our community-based trauma center instituted an opioid-minimizing, multi-modal pain control (MMPC) protocol. The classes of pain medication included a non-opioid analgesic, a non-steroidal anti-inflammatory drug, a gabapentinoid, a skeletal muscle relaxant, and a topical anesthetic. We hypothesize that the MMPC will result in lower opioid consumption compared with the prior STP as evidenced by lower morphine milligram equivalents (MME) per day. METHODS: All adult patients (≥18 years) admitted to the ACS service from Jan 2014 to Dec 2015 and Jan 2018 to Dec 2019 were screened for inclusion. The standard pain control group (STP) and MMPC groups were defined by the year of admission. The primary outcome is opioid use per day, calculated in MME received. Secondary outcomes of the study include daily pain scores, incidence of opioid-related complications, death, ventilator days, intensive care unit length of stay, and hospital length of stay (HLOS) days. RESULTS: Multi-modal pain control protocol group was older and less injured than STP group. Daily opioid utilization was significantly less in the MMPC group (22.5 MMEs/d vs 60MMEs/d in the STP group, P < .0001). Additionally, daily pain scores were not different between groups. Secondary outcomes did not vary between the two groups. CONCLUSION: This study shows that implementation of a MMPC protocol resulted in lower opioid consumption in injured patients. Pain was equivalently controlled during the MMPC protocol period as demonstrated by similar pain scores.

Age-Related Injuries From Escalators.

INTRODUCTION: Escalators and moving stairways are omnipresent in modern life. No study to date has examined nationwide incidence and outcomes associated with injuries directly related to escalator use. The aim of this study was to describe the injury patterns, incidence, and disposition as it pertains to youth compared to adults. METHODS: Descriptive and comparative analyses were performed using National Electronic Injury Surveillance System data. The frequencies of categorical variables were calculated across the two age groups. Chi-squared test was performed on all categorical variables. Significance was defined as two-tailed P < 0.05. Logistic regression was used on variables that were determined to be significant from the frequency tables, with additional variable selection being used to arrive on a final model for each outcome. RESULTS: From 2009 to 2019, there were 810 youth and 3669 adults injured in escalator-associated emergency department visits. Incidence in the youth population decreased over time. Disposition was similar between groups. Injury types were similar among groups. White female adults were more likely to sustain injuries related to escalator use. Adult patients were also significantly more likely to sustain head/neck/facial trauma. Last, adult patients were found to be more likely to suffer a fatal event in comparison to the youth population. DISCUSSION: Differences in the injury patterns between youth and adult patients related to the use of escalators illustrate a need for improved injury prevention. Improved education and safety guidelines, particularly in individuals in ages 18 and up, would likely lessen the discrepancies between age groups identified in this study.