K. Sloan1, J. Cartwright2, J. Liao1, Y. M. Liu1, K. S. Romanowski1 1University Of Iowa Hospitals And Clinics,Department Of Surgery,Iowa City, IA, USA 2University Of Michigan,Ann Arbor, MI, USA
Introduction: Achieving adequate pain control is a vital yet challenging component of burn management. Pharmacological interventions with opioids and adjuvants have long been the cornerstone of burn pain management. Since background pain is innate to burn injuries, long-acting pain medication (LAPM) are particularly advantageous to attain stable analgesia. However, literature is lacking surrounding their utilization and efficacy. The purpose of this survey was to assess burn providers’ beliefs and practices surrounding LAPMs in burn analgesic management.
Methods: Following approval by the Institutional Review Board and the American Burn Association (ABA) Survey Advisory Panel, a 31-item survey concerning LAPM was distributed electronically through Google Forms and REDCap to all physician, physician assistant, and nurse practitioner members of the ABA. Descriptive statistics and analysis of variance were conducted as indicated.
Results: Of 194 respondents (36.7% response rate), 101 (52%) identified as prescribers of pain medications with 93% utilizing LAPM. A majority of prescribers (73.4%) reported being likely or extremely likely to prescribe LAPM to burn patients. The most common trigger for initiation was “patient’s complaints of pain” (82%). Practitioners were evenly divided on whether burn size would influence their use of LAPM (46% no, 43% yes). Almost half of the respondents (47.25%) would utilize LAPM in burns as small as < 10% TBSA. Patient age was cited as consideration in the use of LAPM by 44% of practitioners with 13.5% of practitioners not using LAPM in patients aged 70 or older. In adults, methadone was the most common first line therapy (44%), but was closely followed by extended-release morphine (31%). There was no consistent starting dose or regimen identified among practitioners. Only 21 (22.3%) practitioners cited that their institution had a protocol for the administration of LAPM. Clinical response was the principal reason for altering initial medication choice (18%), with excessive sedation being the chief variable stimulating reduction or with-holding of doses (90%). Analysis of provider perceptions of the effectiveness of LAPM revealed over 97% agreed/strongly agreed LAPM diminish background pain. While only 52% agreed/strongly agreed LAPM reduce the overall adjuvant pain medication requirement, over 90% agreed/strongly agreed that the usage of LAPM was associated with reduction in amount and/or dose of short-acting opioids.
Conclusions: While LAPM use was common among survey respondents and their attitudes towards it were largely positive, there was variance in individual practice and a lack of institutional protocols for use. More research into the most effective administration, dosing and weaning protocols must occur in light of the worsening opioid addiction crisis.