Opioid stewardship in pediatric surgery: Approaching zero
jpedsurg.org shows its articles on its own site.
Read the article on jpedsurg.org ↗Article · Sep 2020 · 1 min read
In brief
In brief
Retrospective study of 394 pediatric surgical procedures demonstrated that adequate postoperative pain control can be achieved with minimal opioid prescriptions at discharge, with only 3 of 352 patients requiring opioids and 86% reporting pain scores ≤3. This opioid-sparing approach using scheduled nonopioid medications resulted in no pain-related readmissions and only one ED visit for pain.
Written by the GCMD Library team from the article.
Abstract
Introduction
In response to the opioid epidemic, we hypothesized that adequate pain control can be achieved with few, if any, opioid prescriptions at discharge following pediatric surgical procedures.
Methods
All records for patients 0–15 years old who underwent pediatric surgical operations from December 2017 through May 2018 were reviewed. Opioids prescriptions, emergency department (ED) visits, and hospital readmissions were recorded. Postoperative pain was assessed on a scale from 0 to 10 via phone call within three days of discharge.
Results
352 patients underwent 394 surgical procedures. Three patients were prescribed opioids at discharge. There were no pain-related readmissions. One patient returned to the ED owing to pain. 116 unique pain scores were obtained from 114 patients: score 0 (n = 69, 59%), 1–3 (n = 31, 27%), 4–5 (n = 11, 9%), 6–8 (n = 5, 4%), and 9–10 (n = 0, 0%). There was a positive association between pain and increasing age (r = 0.26, p = 0.005). No patients who underwent hernia repair reported a pain score greater than 3.
Conclusions
Adequate pain control at discharge after pediatric general surgical procedures can be achieved for most children with scheduled nonopioid medications only. A limited supply of opioids for analgesia after discharge may benefit small subset of patients. This strategy would help reduce opioid prevalence in the community.
Type of study
Retrospective cohort study.
Level of evidence
Level III.