Trauma pain regimen

[europeman]

I'm at a busy trauma center where pain service is needed for a pca

Now im all about giving round the clock Tylenol and NSAIDs (if no Ortho injuries), but here
For virtually every patient, standing baclofen and lyrica/neurontin is added on.

Now if a patent is a paraplegic or partial spinal patient, then early tx with lyrica makes sense. If patient has huge thoracotomy without muscle sparing, then baclofen makes sense.


But they will give baclofen to a patient with midline laparotomy (goes thru Linea alba.... Not muscle)or a chest tube. Lyrica a close second


Am I missing something? I understand the concept of narcotic sparing,
But it seems we are using too Many drugs.

I'm oblivious to standard of care, and guidelines which is why I ask you all!


Thanks!

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[101N]

Somebody on the P&T committee must own stock in Pfizer.

 

[powermd]

I'm at a busy trauma center where pain service is needed for a pca

Now im all about giving round the clock Tylenol and NSAIDs (if no Ortho injuries), but here
For virtually every patient, standing baclofen and lyrica/neurontin is added on.

Now if a patent is a paraplegic or partial spinal patient, then early tx with lyrica makes sense. If patient has huge thoracotomy without muscle sparing, then baclofen makes sense.


But they will give baclofen to a patient with midline laparotomy (goes thru Linea alba.... Not muscle)or a chest tube. Lyrica a close second


Am I missing something? I understand the concept of narcotic sparing,
But it seems we are using too Many drugs.

I'm oblivious to standard of care, and guidelines which is why I ask you all!


Thanks!

I believe the standard of care is to simply escalate opioids for adequate coverage from the OR to the floor, and gradually taper from there. PCAs are the most convenient and patient friendly way to do this. Any opiate sparing agents you can use are a bonus. For example, preop gabapentin, nerve blocks and/or intraop ketamine, post op epidural infusions, PO APAP, and other adjunctive agents that make sense for they type of pain you're treating. Opioid need tapers pretty rapidly for most surgery, so patients shouldn't need more than a few days to weeks of treatment. After that, use of opioids should be tied to function. In other words taking some oxy or hydro is okay, provided it is being used to achieve a functional goal, like get through PT or exercise. Allowing patients to veg out on their meds is a recipe for treatment failure.