No pain is gain: A prospective evaluation of strict non-opioid pain control after pediatric appendectomy
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Mar 2020 · 1 min read
In brief
In brief
Prospective study of 120 pediatric patients demonstrates that strict non-opioid pain control using alternating acetaminophen and ibuprofen achieves 85-100% parent-reported success rates after laparoscopic appendectomy for nonperforated appendicitis. Pain scores decreased significantly from 4.7 on POD1 to 0.7 by POD5, supporting opioid-sparing protocols as standard care.
Written by the GCMD Library team from the article.
Introduction
Opiates are often prescribed after pediatric operations despite safety concerns and lack of evidence confirming superiority compared to other pain control modalities. In this study, we use daily parental surveys to prospectively evaluate a strict non-opioid pain control strategy after laparoscopic appendectomy.
Methods
After IRB approval, children who underwent laparoscopic appendectomy for nonperforated acute appendicitis were recruited to the study. For these patients, our standard practice is to provide instructions to administer alternating acetaminophen and ibuprofen over-the-counter (OTC) postoperatively, and no opiate prescriptions are written. Parents of enrolled children received a daily RedCap survey via text message or e-mail on postoperative days (POD) 1 through 5 to prospectively assess pain control and medication usage. Trends were compared across postoperative days.
Results
One hundred twenty patients were enrolled in the study, and none received opiate prescriptions. Postoperative pain survey response rates were 54% on POD1, 47% on POD2, 35% on POD3, 34% on POD4, and 29% on POD5. Pain level was 4.7 ± 2.3 (out of 10) on POD1, and down-trended significantly each postoperative day to reach 0.7 ± 1.2 by POD5. On POD1, 85% of parents administered OTC medications, which reduced significantly to 14% by POD5. Parent-reported success rates to manage pain by OTC regimen were 85% on POD1, 94% on POD2, 91% on POD3, and 100% on POD4 and POD5.
Conclusion
Strict non-opioid pain control after appendectomy exhibits high performance based upon prospective parental surveys. This strategy should be implemented as standard of care and tested for application to other surgical conditions.
Level of Evidence
Level II.