Risk factors for opioid use disorder after severe burns in adults

DeJesus, Jana E.; Shah, Nikhil R.; Franco-Mesa, Camila; Walters, Elliot T.; Palackic, Alen; Wolf, Steven E.

doi:10.1016/j.amjsurg.2022.09.023

The American Journal of Surgery

2023

DOI: 10.1016/j.amjsurg.2022.09.023

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Risk factors for opioid use disorder after severe burns in adults

Jana E. DeJesus¹,

Nikhil R. Shah²,

Camila Franco-Mesa³

et al.

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Cited by 5 publications

References 51 publications

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Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

Luedi

Andereggen

2023

Curr Pain Headache Rep

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Purpose of Review Pharmacological therapy for acute pain carries the risk of opioid misuse, with opioid use disorder (OUD) reaching epidemic proportions worldwide in recent years. This narrative review covers the latest research on patient risk factors for opioid misuse in the treatment of acute pain. In particular, we emphasize newer findings and evidence-based strategies to reduce the prevalence of OUD. Recent Findings This narrative review captures a subset of recent advances in the field targeting the literature on patients’ risk factors for OUD in the treatment for acute pain. Besides well-recognized risk factors such as younger age, male sex, lower socioeconomic status, White race, psychiatric comorbidities, and prior substance use, additional challenges such as COVID-19 further aggravated the opioid crisis due to associated stress, unemployment, loneliness, or depression. Summary To reduce OUD, providers should evaluate both the individual patient’s risk factors and preferences for adequate timing and dosing of opioid prescriptions. Short-term prescription should be considered and patients at-risk closely monitored. The integration of non-opioid analgesics and regional anesthesia to create multimodal, personalized analgesic plans is important. In the management of acute pain, routine prescription of long-acting opioids should be avoided, with implementation of a close monitoring and cessation plan.

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Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

Luedi

Andereggen

2023

Curr Pain Headache Rep

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Subhypnotic Intravenous Ketamine Improves Patient Satisfaction With Burn Wound Care: A Quality Improvement Project

Pedroza,

Fleishhacker,

Aguillon Paulsen

et al. 2024

Journal of Burn Care &Amp; Research

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Despite advancements in pain management for burn injuries, analgesia often fails to meet our patients’ needs. We hypothesized that low doses of intravenous ketamine as an adjunct to our current protocol would be safe, improving both nurse and patient satisfaction with analgesia during hydrotherapy. Burn patients admitted who underwent hydrotherapy from 6-1-2021 to 6-30-2023 were surveyed. Ketamine was administered with the standard opioid-midazolam regimen. Demographics, oral morphine equivalents (OME), midazolam, ketamine doses and time of administration, and adverse events were collected. Patient and nurse satisfaction scores were collected. The ketamine and no-ketamine groups were compared. P < 0.05 was considered significant. Eighty-five hydrotherapies were surveyed, 47 without ketamine and 38 with ketamine. Demographics, comorbidities, %TBSA, and hospital length of stay were not different. The median amount of ketamine given was 0.79 mg/kg [0.59-1.06]. Patients who received ketamine were more likely to receive midazolam (100% vs. 61.7%; p < 0.001) and both oral and IV opioids (94.7% vs. 68.1%; p = 0.002) prior to hydrotherapy and less likely to receive rescue opioids or midazolam during hydrotherapy. Two patients in the ketamine group had hypertension (defined as SBP > 180) that did not require treatment. Nurses tended to be more satisfied with patient pain control when ketamine was used (10 [8-10] vs. 9 [7-10], p = 0.072). Patient satisfaction was higher in the ketamine group (10 [8.8-10] vs. 9 [7-10], p = 0.006). Utilizing subhypnotic dose intravenous ketamine for hydrotherapy is safe and associated with increased patient satisfaction.

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An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury

Hill,

Reger,

Todor

et al. 2024

Journal of Burn Care &Amp; Research

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Studies focusing on pharmacotherapy interventions to aid patients after thermal injury are a minor focus in burn injury-centered studies and published across a wide array of journals, which challenges those with limited resources to keep their knowledge current. This review is a renewal of previous years’ work to facilitate extraction and review of the most recent pharmacotherapy-centric studies in patients with thermal and inhalation injury. Twenty-three geographically dispersed, board-certified pharmacists participated in the review. A MeSH-based, filtered search returned 2,336 manuscripts over the previous 2-year period. After manual review, 98 (4%) manuscripts were determined to have a potential impact on current pharmacotherapy practice. The top 10 scored manuscripts are discussed. Only 17% of those reviewed were assessed to likely have little effect on current practice. The overall impact of the current cohort was higher than previous editions of this review, which is encouraging. There remains a need for investment in well-designed, high impact, pharmacotherapy-pertinent research for patients sustaining thermal or inhalation injuries.

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Risk factors for opioid use disorder after severe burns in adults

Cited by 5 publications

References 51 publications

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

Acute Pain and Development of Opioid Use Disorder: Patient Risk Factors

Subhypnotic Intravenous Ketamine Improves Patient Satisfaction With Burn Wound Care: A Quality Improvement Project

An Appraisal of Pharmacotherapy-Pertinent Literature Published in 2021 and 2022 for Clinicians Caring for Patients With Thermal or Inhalation Injury

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