Monday, January 8, 2018

Pain Control

R.E.B.E.L.EM - January 8, 2017 - By Salim Rezaie
"Background: In the United States we are not only seeing an opioid epidemic but also a shortage of IV opioid agents. For both reasons, it is important to find non-opioid options for common pain complaints seen in the ED. Changing prescribing practices is difficult but an important step in minimizing opioid usage. Current research suggests that even short term opioid use can cause a predisposition to subsequent opioid dependence. In the spirit of doing no harm, we as a healthcare community should look to find other less harmful ways to decrease pain and suffering. In this episode, we will review four randomized clinical trials published in the past year on pain control to see if there is evidence to support other non-opioid options...
Clinical Bottom Lines:
  • IN ketamine 1mg/kg provides effective analgesia in renal colic
  • Ibuprofen 400mg combined with acetaminophen 1000mg can reduce pain in mild to moderate extremity injuries
  • In renal colic, a ketorolac 15mg IV first strategy is still appropriate, with the addition of an IV opioid only if pain is not adequately controlled
  • In patients 60 years of age or older, presenting to the ED with hip fractures, femoral nerve blocks with 20mL of 0.5% bupivacaine not only improves pain, but also increase mobility and functional outcomes with significantly less medication side effects when compared to IV opioid agents"