Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective.
Challenges with opioids (e.g., adverse events, misuse and abuse with long-term administration) have led to a renewed emphasis on opioid-sparing multimodal management of trauma pain. To assess the extent to which currently available evidence supports the efficacy and safety of various nonopioid analgesics and techniques to manage trauma pain, a literature search of recently published references was performed. Additional citations were included on the basis of authors' knowledge of the literature. Effective options for opioid-sparing analgesics include oral and intravenous (IV) acetaminophen; nonsteroidal anti-inflammatory drugs available via multiple routes; and anticonvulsants, which are especially effective for neuropathic pain associated with trauma. Intravenous routes (e.g., IV acetaminophen, IV ketorolac) may be associated with a faster onset of action than oral routes. Additional adjuvants for the treatment of trauma pain are muscle relaxants and alpha-2 adrenergic agonists. Ketamine and regional techniques play an important role in multimodal therapy but require medical and nursing support. Nonpharmacologic treatments (e.g., cryotherapy, distraction techniques, breathing and relaxation, acupuncture) supplement pharmacologic analgesics and can be safe and easy to implement. In conclusion, opioid-sparing multimodal analgesia addresses concerns associated with high doses of opioids, and many pharmacologic and nonpharmacologic options are available to implement this strategy. Nurses play key roles in comprehensive patient assessment; administration of patient-focused, opioid-sparing, multimodal analgesia in trauma; and monitoring for safety concerns.
Anesthesiology/Pain Management Service, Jacobi Medical Center, Bronx, New York (Ms Sullivan); Inpatient Pain Management, Northwestern Medicine-Central DuPage Hospital, Winfield, Illinois (Ms Lyons); Anesthesiology, University of Colorado Hospital, Aurora, Colorado (Dr Montgomery); and Clinical Outcomes, New Hanover Regional Medical Center, Wilmington, North Carolina (Dr Quinlan-Colwell).
Denise
D
Sullivan
Mary
M
Lyons
Robert
R
Montgomery
Ann
A
Quinlan-Colwell
D000284:Administration, Oral; D000698:Analgesia / Q000379:methods; D000700:Analgesics / Q000008:administration & dosage* / Q000494:pharmacology; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D014193:Trauma Centers / Q000458:organization & administration*; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000175:diagnosis*
D000700:Analgesics; D000894:Anti-Inflammatory Agents, Non-Steroidal