Trauma and treatment: Pain management in Puerto Rican elders visiting the emergency department

Context: Pain management in elderly trauma patients is complicated by age-related physiological changes, comorbidities, and limited treatment resources. In low-resource settings such as southern Puerto Rico, emergency department (ED) pain management practices remain understudied. Objectives: To describe patterns of analgesic use, including multimodal opioid-sparing strategies, and evaluate their association with ED length of stay in elderly trauma patients in a low-resource ED. Methods: A retrospective review was conducted of 3,000 ED visits by patients aged ≥65 with simple trauma from 2022-2024. After random sampling, 1,212 patients met inclusion criteria. Data on demographics, comorbidities, injury type, analgesics administered, and ED length of stay were collected. Statistical analyses included chi-square tests, linear regression, and independent t-tests. Results: Of the 1,212 patients, 61% were female and 86% had at least one chronic condition. Common injuries included head (34.9%), lower extremity (24%), and upper extremity (21.9%). Analgesics were administered to 79.6% of patients, with acetaminophen (41.7%) and (ketorolac) (31.3%) being the most frequently administered. Opioids were used in 4.7% of cases. Local anesthetics were administered to 18.7%. Multimodal treatment (use of ≥2 analgesic types) was administered to 15.7% of patients. Ketorolac use correlated with shorter ED stays (mean 32 minutes less, p=0.012), while opioid use correlated with longer stays (mean 1 hour 58 minutes more, p=0.012). Conclusion: These findings underscore the importance of developing geriatric-specific, multimodal opioid-sparing pain protocols tailored to low-resource EDs and expanding training in local anesthetic techniques to optimize non-opioid analgesia and improve care in similar settings.