• Gabrielle E Hatton, Heather R Kregel, Claudia Pedroza, Thaddeus J Puzio, Sasha D Adams, Charles E Wade, Lillian S Kao, and John A Harvin.
• Department of Surgery, Division of Acute Care Surgery, McGovern Medical School at UTHealth, Houston, Texas.
• Ann. Surg. 2021 Oct 1; 274 (4): 565571565-571.

ObjectiveEvaluate the effect of age on opioid consumption after traumatic injury.Summary Background DataOlder trauma patients receive fewer opioids due to decreased metabolism and increased complications, but adequacy of pain control is unknown. We hypothesized that older trauma patients require fewer opioids to achieve adequate pain control.MethodsA secondary analysis of the multimodal analgesia strategies for trauma Trial evaluating the effectiveness of 2 multimodal pain regimens in 1561 trauma patients aged 16 to 96 was performed. Older patients (≥55 years) were compared to younger patients. Median daily oral morphine milligram equivalents (MME) consumption, average numeric rating scale pain scores, complications, and death were assessed. Multivariable analyses were performed.ResultsOlder patients (n = 562) had a median age of 68 years (interquartile range 61-78) compared to 33 (24-43) in younger patients. Older patients had lower injury severity scores (13 [9-20] vs 14 [9-22], P = 0.004), lower average pain scores (numeric rating scale 3 [1-4] vs 4 [2-5], P < 0.001), and consumed fewer MME/day (22 [10-45] vs 52 [28-78], P < 0.001). The multimodal analgesia strategies for trauma multi-modal pain regimen was effective at reducing opioid consumption at all ages. Additionally, on multivariable analysis including pain score adjustment, each decade age increase after 55 years was associated with a 23% reduction in MME/day consumed.ConclusionsOlder trauma patients required fewer opioids than younger patients with similar characteristics and pain scores. Opioid dosing for post-traumatic pain should consider age. A 20 to 25% dose reduction per decade after age 55 may reduce opioid exposure without altering pain control.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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