Abstract：
INTRODUCTION:An effective strategy to manage acute pain while minimizing opioid exposure is needed for injured patients. In this trial, we aimed to compare two multimodal pain regimens (MMPR) in minimizing opioid exposure and relieving acute pain in a busy, urban trauma center. METHODS:This was an unblinded, pragmatic, randomized, comparative effectiveness trial of all adult trauma admissions except vulnerable patient populations and readmissions. The original MMPR (intravenous administration, followed by oral, acetaminophen, 48 hours of celecoxib and pregabalin followed by naproxen and gabapentin, scheduled tramadol, and as needed oxycodone) was compared to a MMPR with generic medications, termed the MAST MMPR (oral acetaminophen, naproxen, gabapentin, lidocaine patches, and as needed opioids). The primary outcome was oral morphine milligram equivalents (MME) per day and secondary outcomes included total MME during hospitalization, opioid prescribing at discharge, and pain scores. RESULTS:During the trial, 1,561 patients were randomized and included - 787 to the original MMPR and 774 the MAST MMPR. There were no differences in demographics, injury characteristics, or operations performed. Patients randomized to the MAST MMPR had lower MME per day (34 MME/day, IQR [15, 61] versus 48 MME/day, IQR [22,74], p<0.001) and fewer were prescribed opioids at discharge (62% versus 67%, p=0.029; RR 0.92, 95% credible interval 0.86-0.99, posterior probability RR<1 = 0.99). No clinically significant difference in pain scores were seen. CONCLUSION:The MAST MMPR was a generalizable and widely available approach that reduced opioid exposure after trauma and achieved adequate acute pain control.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Harvin JA,Albarado R,Thanh Truong VT,Green C,Tyson JE,Pedroza C,Wade CE,Kao LS,MAST Study Group.doi
10.1016/j.jamcollsurg.2020.12.014subject
Has Abstractpub_date
2020-12-29 00:00:00eissn
1072-7515issn
1879-1190pii
S1072-7515(20)32576-Xpub_type
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