Nonopioid management of acute pain associated with trauma

Exploring Opioid-Sparing Multimodal Analgesia Options in Trauma: A Nursing Perspective

“…Oral acetaminophen has a long history as an analgesic, and its mechanism of action involves the inhibition of prostaglandin synthesis (Oyler et al, 2015). A study of osteoarticular injuries in the ED showed significantly improved pain intensity with oral acetaminophen over time (Viallon et al, 2007).…”

“…Food and Drug Administration, 2011). In patients with compromised liver function, including many elderly patients and those abusing alcohol, the use of any level of acetaminophen requires caution (Oyler et al, 2015). Because an estimated 16.4% of injuries in EDs are attributable to alcohol, the safety risk of acetaminophen products related to alcohol should be considered when creating an analgesic plan (Cherpitel et al, 2015).…”

“…The mechanism of action of oral and intravenous (IV) acetaminophen is the same (Oyler et al, 2015). Although IV acetaminophen was approved in the United States in 2010, it has a longer history of efficacy and safety because of its availability in Europe since 2002 (Viscusi, Singla, Gonzalez, Saad, & Stepanian, 2012).…”

“…In summary, data suggest that IV acetaminophen effectively relieves pain, may have a faster onset of action than oral acetaminophen, is theoretically less hepatotoxic than oral acetaminophen, and is opioid-sparing; these properties may be advantageous in trauma populations, including military patients with combat-related injuries (Vokoun, 2015). Overall, acetaminophen is considered an effective analgesic that can be included in a multimodal analgesic plan when contraindications and safety issues are considered (Barr et al, 2013; Oyler et al, 2015). …”

“…Nonsteroidal anti-inflammatory drugs (NSAIDs) produce their opioid-sparing analgesic effects through inhibition of cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) (Oyler et al, 2015) and have been recommended as adjunctive analgesics in the ICU (Barr et al, 2013). Oral ibuprofen demonstrated similar efficacy as orally administered morphine in a double-blind trial of children with fractures (Poonai et al, 2014).…”