61 The Use of Methadone Plus Gabapentin As a Multimodal Pain Regimen Compared With Traditional Pain Management Protocols in Burn Patients: A Retrospective Study

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Pain is unavoidable after burn injury and treatment to reduce the severity is critical to successful outcome. Yet traditional approaches using opioid narcotics with sedatives such as benzodiazepines trade pain and agitation control for serious side effects that would ultimately have a negative impact on the recovery goal. In October 2014 we switched to an analgesia approach using methadone and Gabapentin. We retrospectively reviewed the impact of this new pain protocol compared to the more traditional Morphine plus benzodiazepine therapy. A review of patients from 2013 to 2016 on the traditional therapy, compared to patients on the new program from 2014 to 2017. This review included an analysis of EHR for groups of 61 patients treated with methadone/Gabapentin (new program) as well as those patients treated with traditional opiate/opioids and benzodiazepines. Data was extracted for demographic information, wound severity, as well as assessment of level of pain management, nutrition tolerance, bowel function, and cost. Delirium and sedation measurements were acquired as RASS scores, and used as indicators for comparison between the two groups. The two groups were equivalent in age, sex, ethnicity, BMI, diabetes and smoking. The methadone cohort had significantly higher total body surface area, yet their average reported pain level was significantly lower (P <0.033) and they required markedly less morphine equivalent doses (P <0.04). They also had significantly less frequent over sedation episodes (p<0.006), significantly improved bowel movements (P<0.001) with less episodes of constipation and late defecation, and significant reduction in cost (P<0.001) compared to the traditional group. An analgesic-only, enteral, background pain management protocol with methadone and gabapentin is superior to the traditional pain control regimen. It provides a better pain control while significantly reducing many of the unwanted side effects of the traditional method. The pain management protocol we describe in our research is a definite improvement from traditional pain management protocols in that it provides very adequate pain reduction while eliminating the problematic side effects caused by these traditional approaches.

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