Development of an opioid reduction protocol in an emergency department.

Purpose: Results of a study of an opioid-sparing protocol for acute pain management in the emergency department (ED) are reported.

Methods: The ED of a large hospital conducted a project, the "Opioid-Free Shift," to test a multimodal pharmacologic approach to analgesic therapy as an alternative to routine use of opioids. During a specified eight-hour period, all adults arriving at the ED with a complaint of pain were treated according to an opioid-sparing protocol based on principles of channel enzyme receptor-targeted analgesia (CERTA). Pain severity was assessed at baseline and at 30 and 60 minutes after analgesia administration using a validated rating scale.

Results: Seventeen patients were treated in the ED for acute or chronic pain during the study period. The median pain score on the 11-point rating scale was 8 (range, 4-10) at baseline, declining to 6 (range, 0-10) at 30 minutes and to 5 (range, 1-10) at 60 minutes. At 30 minutes, 7 patients (41%) had a pain score reduction of ≥ 30% and 3 (18%) had a reduction of ≥ 50%. Six of the 15 patients (40%) reassessed at 60 minutes had a pain score reduction of ≥ 30%; 4 patients (27%) had a reduction of ≥ 50%. More than 80% of patients were satisfied with the pain relief provided through the CERTA-based protocol, and no adverse drug reactions were reported.

Conclusion: The 17 patients treated for acute or chronic pain during the opioid-free shift were managed mainly with i.v. ketorolac and oral ibuprofen, with only 1 patient requiring rescue opioid therapy.