(1542) Phenobarbital Safety and Efficacy for Alcohol Withdrawal Prophylaxis: Use at a Level 1 Trauma Center

Introduction: Trauma patients are at high risk for developing alcohol withdrawal syndrome (AWS). As such, the American College of Surgeons Committee recommends a screening process to identify and intervene for those at high risk. Limited data exists regarding strategies for preventing AWS in this setting. Phenobarbital is an attractive option given its prolonged half-life and demonstrated safety in intensive care patients. The present study aims to describe our institution’s experience with phenobarbital for prevention of AWS and safety of this intervention.

Methods: This was a retrospective, single-center cohort study that included adult trauma patients admitted to a large academic level 1 trauma center between January 2020 through August 2022. Patients were included if they received at least two doses of phenobarbital 65-130 mg orally or intravenously twice to three times daily. The primary efficacy outcome was development of AWS, with safety outcomes including somnolence, respiratory depression requiring intubation, and pertinent side effects.

Results: 118 patients were included. A majority of patients were male (87.3%), experienced a blunt mechanism of injury (90.7%) and were admitted to the ICU (83.9%). 85.6% of patients had an elevated ethanol level on admission and 14.4% of patients had a history of prior withdrawal. In addition, 35.6% had a positive urine drug screen. A majority of patients (76.3%) received phenobarbital 65 mg BID-TID. For the efficacy outcome, 3.4% developed AWS. Adjunct medications for symptom management were used in 32.2% of patients, with 10.2% of patients requiring dose escalations of phenobarbital. For our safety outcome, somnolence was noted in 8.4% of patients, with 3.4% of patients requiring dose de-escalation. 13 patients (11%) had a documented RASS below -2, although 11 of these patients were receiving continuous infusions of analgesia or sedation at that time. Zero patients required intubation secondary to oversedation or respiratory depression. There were no cases of propylene glycol toxicity.

Conclusions: Scheduled phenobarbital may be a safe and effective medication for prevention of AWS in the at risk trauma population. Larger, comparative studies are needed for confirmation of these findings.