Age-Related Opioid Exposure In Trauma: A Secondary Analysis Of The Multimodal Analgesia Strategies For Trauma (MAST) Randomized Trial
*Gabrielle E Hatton, *Heather R Kregel, *Thaddeus J Puzio, *Sasha D Adams, *Charles E Wade, Lillian S Kao, *John A Harvin
McGovern Medical School at UTHealth, Houston, TX
OBJECTIVE(S): Older trauma patients receive fewer opioids due to decreased metabolism and increased complications, but adequacy of pain control is unknown. We hypothesized that older trauma patients require fewer opioids to achieve adequate pain control.
METHODS: A secondary analysis of the MAST Trial, which evaluated the effectiveness of two multi-modal pain regimens in 1,561 trauma patients aged 16 to 96, was performed. Older patients (≥55 years) were compared to younger patients. Median daily oral morphine milligram equivalents (MME) consumption, average numeric rating scale (NRS) pain scores, complications, and death were assessed. Multivariable analyses were performed.
RESULTS: Older patients (n=562) had a median age of 68 years (IQR 61-78) compared to 33 (24-43) in younger patients. Compared to younger patients, older patients had lower injury severity (13 [9-20] vs 14 [9-22], p=0.004), and pain scores (NRS 3 [1-4] vs 4 [2-5], p<0.001), and consumed fewer MME/day (22 [10-45] vs 52 [28-78], p<0.001). Complications and mortality were more frequent in older patients. On multivariable analysis including pain score adjustment, each decade age increase was associated with a 13% reduction in MME/day consumed (11-15%, p<0.001, Figure).
CONCLUSIONS: Older trauma patients required fewer opioids than younger patients with similar characteristics and pain scores. Initial opioid dosing for post-traumatic pain should consider age. A 10-15% dose reduction per decade may reduce opioid exposure without altering pain control.
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