scholarly journals Cost of Intravenous Analgesia for the Management of Acute Pain in the Emergency Department is Substantial in the United States

10.36469/9793 ◽  
2017 ◽  
Vol 5 (1) ◽  
pp. 1-15 ◽  
Author(s):  
Pamela P. Palmer ◽  
Judith A. Walker ◽  
Asad E. Patanwala ◽  
Carin A. Hagberg ◽  
John A. House
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Severe Pain ◽  
The United States ◽  
Rapid Onset ◽  
Opioid Use ◽  
Nursing Time ◽  
Opioid Administration ◽  
Intravenous Analgesia ◽  
Set Up

Background: Pain is a leading cause of admission to the emergency department (ED) and moderate-to-severe acute pain in medically supervised settings is often treated with intravenous (IV) opioids. With novel noninvasive analgesic products in development for this indication, it is important to assess the costs associated with IV administration of opioids. Materials and Methods: A retrospective observational study of data derived from the Premier database was conducted. All ED encounters of adult patients treated with IV opioids during a 2-year time period, who were charged for at least one IV opioid administration in the ED were included. Hospital reported costs were used to estimate the costs to administer IV opioids. Results: Over a 24 month-period, 7.3 million encounters, which included the administration of IV opioids took place in 614 US EDs. The mean cost per encounter of IV administration of an initial dose of the three most frequently prescribed opioids were: morphine $145, hydromorphone $146, and fentanyl $147. The main driver of the total costs is the cost of nursing time and equipment cost to set up and maintain an IV infusion ($140 ± 60). Adding a second dose of opioid, brings the average costs to $151-$154. If costs associated with the management of opioid-related adverse events and IV-related complications are also added, the total costs can amount to $269-$273. Of these 7.3 million encounters, 4.3 million (58%) did not lead to hospital admission of the patient and, therefore, the patient may have only required an IV catheter for opioid administration. Conclusions: IV opioid use in the ED is indicated for moderate-to-severe pain but is associated with significant costs. In subjects who are discharged from the ED and may not have required an IV for reasons other than opioid administration, rapid-onset analgesics for moderate-to-severe pain that do not require IV administration could lead to direct cost reductions and improved care.

scholarly journals Patient-Reported Opioid Pill Consumption After an ED Visit: How Many Pills Are People Using?

Pain Medicine ◽  
2020 ◽  
Author(s):  
Danielle M McCarthy ◽  
Howard S Kim ◽  
Scott I Hur ◽  
Patrick M Lank ◽  
Christine Arroyo ◽  
...  
Keyword(s):  
Emergency Department ◽  
Back Pain ◽  
Acute Pain ◽  
Renal Colic ◽  
Opioid Consumption ◽  
Fracture Dislocation ◽  
Opioid Use ◽  
Use Patterns ◽  
Patient Demographics ◽  
Patient Reported

Abstract Objectives Recent guidelines advise limiting opioid prescriptions for acute pain to a three-day supply; however, scant literature quantifies opioid use patterns after an emergency department (ED) visit. We sought to describe opioid consumption patterns after an ED visit for acute pain. Design Descriptive study with data derived from a larger interventional study promoting safe opioid use after ED discharge. Setting Urban academic emergency department (>88,000 annual visits). Subjects Patients were eligible if age >17 years, not chronically using opioids, and newly prescribed hydrocodone-acetaminophen and were included in the analysis if they returned the completed 10-day medication diary. Methods Patient demographics and opioid consumption are reported. Opioid use is described in daily number of pills and daily morphine milligram equivalents (MME) both for the sample overall and by diagnosis. Results Two hundred sixty patients returned completed medication diaries (45 [17%] back pain, 52 [20%] renal colic, 54 [21%] fracture/dislocation, 40 [15%] musculoskeletal injury [nonfracture], and 69 [27%] “other”). The mean age (SD) was 45 (15) years, and 59% of the sample was female. A median of 12 pills were prescribed. Patients with renal colic used the least opioids (total pills: median [interquartile range {IQR}] = 3 [1–7]; total MME: median [IQR] = 20 [10–50]); patients with back pain used the most (total pills: median [IQR] = 12 [7–16]; total MME: median [IQR] = 65 [47.5–100]); 92.5% of patients had leftover pills. Conclusions In this sample, pill consumption varied by illness category; however, overall, patients were consuming low quantities of pills, and the majority had unused pills 10 days after their ED visit.

The use of Penthrox (methoxyflurane) in trauma patients

2019 ◽  
Vol 1 (9) ◽  
pp. 454-457
Author(s):  
Manuel Sevillano-Barbero ◽  
Claire Ruddy
Keyword(s):  
Emergency Department ◽  
Acute Pain ◽  
Half Life ◽  
Severe Pain ◽  
Hospital Setting ◽  
Trauma Patients ◽  
Emergency Relief ◽  
Non Invasive ◽  
Continuous Use ◽  
The Ideal

Penthrox (methoxyflurane) is an inhaled analgesic. It is a non-invasive, lightweight, portable handheld inhaler indicated for the emergency relief of moderate-to-severe pain in conscious adult patients with trauma. It is becoming very popular in the pre-hospital setting and in the emergency department and has been proven to reduce acute pain within 6–10 inhalations. One 3 ml bottle will provide effective analgesic relief for up to 30 minutes (continuous use) or 1 hour (intermittent use). With very few drug interactions and a short half-life, it is the ideal analgesic for conscious patients. However, it is not recommended to use regularly and should not replace a good analgesic approach.

The Use of Intravenous Lidocaine for the Management of Acute Pain Secondary to Traumatic Ankle Injury: A Case Report

2017 ◽  
Vol 31 (1) ◽  
pp. 126-129 ◽  
Author(s):  
Billy Sin ◽  
Diana Gritsenko ◽  
Grace Tam ◽  
Kimberly Koop ◽  
Eva Mok
Keyword(s):  
Emergency Department ◽  
Case Report ◽  
Acute Pain ◽  
Single Case ◽  
Case Series ◽  
The United States ◽  
Prescribing Patterns ◽  
Intravenous Lidocaine ◽  
Inpatient Hospitalization ◽  
Acute Distress

Sports-related injuries are a frequent cause of visits to the emergency department (ED) across the United States. A majority of these injuries affect the lower extremities with the ankle as the most frequently reported site. Most sports-related injuries are not severe enough to require inpatient hospitalization; however, they often lead to acute distress and pain which require prompt treatment with analgesics. Approximately 22% of patients who presented to the ED required pharmacotherapy for acute pain management. Opioids have been traditionally used for the management of severe acute pain in the ED; however, there are growing concerns for opioid overuse and misuse. As a result, there is growing controversy regarding the appropriate selection of analgesic agents, optimal dosing, and need for outpatient therapy which has contributed to changes in prescribing patterns of opioids in the ED. Lidocaine, a class 1b antiarrhythmic, has been utilized as an analgesic agent. Its use has been documented for the management of intractable chronic pain caused by cancer, stroke, neuropathies, or nephrolithiasis. However, literature describing the use of intravenous lidocaine for the management of acute pain secondary to trauma is limited to a single case series. This case report describes the use of intravenous lidocaine in a 17-year-old male who presented to the ED in acute distress secondary to ankle dislocation and fracture. This report serves to describe additional clinical experience with intravenous lidocaine for the management of acute pain secondary to ankle fracture in the emergency department.

scholarly journals Emergency Department Visits and Trends Related to Cocaine, Psychostimulants, and Opioids in the United States, 2008-2018

2021 ◽  
Author(s):  
Leslie W. Suen ◽  
Thibaut Davy-Mendez ◽  
Kathy T. LeSaint ◽  
Elise D. Riley ◽  
Phillip Coffin
Keyword(s):  
Emergency Department ◽  
Drug Toxicity ◽  
The United States ◽  
Emergency Department Visits ◽  
Opioid Use ◽  
Stimulant Use ◽  
Care Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Psychiatric Complications

Abstract Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of US ED visits related to cocaine and psychostimulant use, compared to opioid use. Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. We excluded visits related to ≥2 of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69; 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

scholarly journals Opioid Use and Misuse Three Months After Emergency Department Visit for Acute Pain

2019 ◽  
Vol 26 (8) ◽  
pp. 847-855 ◽  
Author(s):  
Raoul Daoust ◽  
Jean Paquet ◽  
Sophie Gosselin ◽  
Gilles Lavigne ◽  
Alexis Cournoyer ◽  
...  
Keyword(s):  
Emergency Department ◽  
Emergency Department Visit ◽  
Acute Pain ◽  
Opioid Use

Treatment of Acute Gout Flares in the Emergency Department: Prescribing Patterns and Revisit Rates

2021 ◽  
pp. 106002802110322
Author(s):  
Luigi Brunetti ◽  
Janaki Vekaria ◽  
Peter E. Lipsky ◽  
Naomi Schlesinger
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
The United States ◽  
Prescribing Patterns ◽  
Care Providers ◽  
Opioid Use ◽  
Hospital Visit ◽  
Opioid Prescription ◽  
Anti Inflammatory ◽  
Gout Flares

Background The incidence and health care costs of gout flares have increased in the United States. The increased costs may be a result of a lack of adherence to treatment guidelines and medication knowledge. Identifying causes for this trend is vital to mitigate inappropriate resource use. Objectives The aim was to identify pharmacotherapy use related to gout treatment before, during hospital visit or stay, and on discharge in patients presenting to the emergency department (ED) with gout flares. Secondary end points included opioid use, revisit rates, and associated risk factors. Methods We performed a retrospective cohort study at a community teaching hospital ED. All consecutive patients visiting the ED from January 2016 to July 2019 with a primary diagnosis of gout flare were included. Data were extracted from the electronic medical records. Results The analysis included 214 patients. Anti-inflammatory medication was not prescribed in 33.6% during the hospital visit and 29.6% of patients on discharge. History of opioid use (odds ratio [OR] = 3.3; 95% CI = 1.3-8.6; P = 0.014) and gastroesophageal reflux disease (OR = 3.5; 95% CI = 1.09-10.9; P = 0.035) were associated with opioid prescription on discharge. ED revisits within 90 days for any gout-related or non–gout-related cause were recorded in 16.8% of patients. Conclusion and Relevance Roughly 30% of patients did not receive an anti-inflammatory on discharge, and opioids were frequently overused in gout management in the ED. There is an opportunity for further education of health care providers regarding gout treatment.

scholarly journals Examination of Symptom Clusters in Acute and Chronic Pain Patients

2014 ◽  
Vol 3;17 (3;5) ◽  
pp. E349-E357
Author(s):  
David Fishbain
Keyword(s):  
Chronic Pain ◽  
Acute Pain ◽  
Severe Pain ◽  
Somatic Symptoms ◽  
The United States ◽  
Symptom Clusters ◽  
Pain Level ◽  
Cluster Number ◽  
Chronic Pain Patients ◽  
Pain Patients

Background: Symptom clusters have not been previously explored in acute pain patients (APPs) and chronic pain patients (CPPs) with non-cancer pain. Objectives: The objectives of this study were to determine in CPPs and APPs which somatic and non-somatic symptoms cluster with each other, the number of clusters, and if cluster number and cluster symptom makeup differ by pain level. Study Design: Study sample was 326 APPs and 341 CPPs who had completed a pool of questions that had included current symptom questions other than pain. Symptom cluster analyses were performed on 15 somatic and non-somatic symptoms for APPs and CPPs and for 2 CPP subgroups with moderate and severe pain. Setting: APPs and CPPs were from rehabilitation facilities located in 30 states in all geographical regions of the United States. Results: APPs had 4 symptom clusters and CPPs had 5. For CPPs, the clusters represented memory, neurological, behavioral, somatic, and autonomic problems. CPPs with moderate and severe pain had 3 and 4 symptom clusters, respectively, and differed in cluster symptom constitution. Limitations: Patients selected themselves for study inclusion and were paid for their participation. This could have affected random selection. Lastly, we used the current time definitions of acute pain versus chronic pain (90 days) to separate our patients into these groups. Currently, no consensus exists regarding the optimal time duration to divide acute from chronic. Conclusions: APPs and CPPs are characterized by symptom comorbidities that form clusters. In CPPs, cluster number and cluster symptom makeup are affected by pain level. This has implications for clinical practice and future research. Key words: Comorbidity, somatic symptoms, comorbid symptoms, chronic pain patients, acute pain patients, community patients without pain, clusters, symptom clusters

scholarly journals Opioid Use During the Six Months After an Emergency Department Visit for Acute Pain: A Prospective Cohort Study

2020 ◽  
Vol 75 (5) ◽  
pp. 578-586 ◽  
Author(s):  
Benjamin W. Friedman ◽  
Lorena Abril Ochoa ◽  
Farnia Naeem ◽  
Hector R. Perez ◽  
Joanna L. Starrels ◽  
...  
Keyword(s):  
Emergency Department ◽  
Cohort Study ◽  
Prospective Cohort Study ◽  
Emergency Department Visit ◽  
Acute Pain ◽  
Prospective Cohort ◽  
Opioid Use
Sign in / Sign up

Export Citation Format

Share Document