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912: AN EVALUATION OF EPIDURAL USAGE AND SAFETY IN THE GERIATRIC TRAUMA PATIENT POPULATION

Introduction/Hypothesis: Injuries caused by blunt thoracic trauma are frequently associated with pulmonary complications such as pneumonia and severe pain, prolonging hospital and ICU length of stay and significantly increasing healthcare costs, especially in elderly patients. Epidural analgesia is the best-studied modality in both thoracic trauma and elective thoracotomies. While the pain relief is often pronounced, it has troublesome potential adverse effects such as hypotension, somnolence, and altered mental status. With increasing age, lipophilic medications have a higher potency and longer duration of action. The objective of this study was to determine the incidence of switching from hydromorphone + bupivacaine to bupivacaine alone continuous infusion epidural therapy in patients ≥ 65 years of age. Methods: This was a retrospective design using a convenience sample of adult trauma ICU patients admitted from 2/1/17 to 2/1/19 who received continuous infusion epidural therapy. Patients were classified as either elderly (≥ 65 years) or nonelderly (< 65 years). The primary endpoint was the incidence of removal of hydromorphone from the epidural order. Secondary endpoints included reason for epidural change and gender of patients who had their epidural changed. Results: A total of 63 patients were included, with 22 patients in the elderly and 41 patients in the non-elderly group. The majority of patients in both groups were started on hydromorphone 20 mcg/mL + bupivacaine 0.06% and there were more females in the elderly group (59.1% vs. 29.3%; p = 0.019). There was a significantly higher rate of hydromorphone removal in the elderly group (27.3% vs. 4.9%; p = 0.018). Reasons for hydromorphone removal included hypotension, somnolence, and altered mental status. All patients included received systemic opioids in addition to epidural therapy. Conclusions: Our results indicate elderly patients are more likely to require removal of hydromorphone from epidural therapy than non-elderly patients. As a result, we have changed practice to empirically utilize a lower concentration of hydromorphonecontaining epidural therapy in geriatric patients. To our knowledge, this study is the first of its kind to evaluate the potential implication of side effects experienced by geriatric trauma patients who receive epidural therapy.