# Pain — GCMD Library living collection

Everything in the library about pain — built automatically from dossiers that name it.

Updated: n/a · 4 episodes · 69 cited statements

## Episodes
### Acute Management
- [Addressing the Opioid Crisis: 2018 Pediatric Surgery Practice Gap #1](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471) — video · [machine version](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471.md)

### Evidence & Research
- [PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424) — video · 11:59 · [machine version](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424.md)
- [David Grabski, MD - Best of the Best in Pediatric Surgery 2024](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020) — video · 9:15 · [machine version](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020.md)

### Case-Based Learning
- [Opioid over prescription: Practice Gap discussion at Update Course 2018](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343) — video · 8:27 · [machine version](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=0) Case presentation and initial discussion of opioid alternatives (Ep 1)
- [2:42](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=162) Disposal programs and the opioid epidemic context (Ep 1)
- [5:20](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=320) Practice change testimonial and disposal methods (Ep 1)
- [0:00](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=0) Opioid Crisis as Top Practice Gap and Clinical Recommendations (Ep 2)
- [1:32](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=92) Engaging the Pediatric Surgery Community in Practice Gap Identification (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=0) Study presentation: perioperative opioid use in pediatric inguinal hernia patients (Ep 3)
- [3:18](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=198) Initial commentary and questions on length of stay, regional blocks, and gender differences (Ep 3)
- [5:04](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=304) Discussion of length of stay, spinal anesthesia, and age considerations (Ep 3)
- [7:48](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=468) Panel questions on study design, laparoscopy, institutional education, and gender dimorphism (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=0) Introduction to presentation on opioid reduction and racial disparity (Ep 4)
- [0:17](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=17) Study design, intervention, and findings on racial disparity in opioid prescribing (Ep 4)
- [5:21](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=321) Discussion of future directions and standardization approaches (Ep 4)
- [6:10](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=370) Discussion of mechanisms underlying the disparity and clinical implications (Ep 4)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients." — Isabel Hageman (clinical) [Ep 3 · 0:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=33)
- "There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults." — Isabel Hageman (guideline) [Ep 3 · 0:40](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=40)
- "The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne." — Isabel Hageman (clinical) [Ep 3 · 0:52](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=52)
- "Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids." — Isabel Hageman (clinical) [Ep 3 · 0:58](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=58)
- "20% of patients received opioids intraoperatively, which was mostly fentanyl." — Isabel Hageman (clinical) [Ep 3 · 1:41](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=101)
- "Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter." — Isabel Hageman (clinical) [Ep 3 · 1:46](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=106)
- "33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids." — Isabel Hageman (clinical) [Ep 3 · 1:53](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=113)
- "No patients received an opiate prescription at discharge." — Isabel Hageman (clinical) [Ep 3 · 2:02](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=122)
- "Increasing age increased the risk for postoperative and total opiate use." — Isabel Hageman (clinical) [Ep 3 · 2:06](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=126)
- "There was a significant association between female sex and total opioid use." — Isabel Hageman (clinical) [Ep 3 · 2:06](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=126)
- "Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids." — Isabel Hageman (clinical) [Ep 3 · 2:16](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=136)
- "Addition of regional blocks significantly lowered postoperative opiate use." — Isabel Hageman (clinical) [Ep 3 · 2:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=143)
- "General anesthesia was found to be a risk for total, but not postoperative opioid use." — Isabel Hageman (clinical) [Ep 3 · 2:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=143)
- "Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world." — Isabel Hageman (opinion) [Ep 3 · 2:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=153)
- "There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients." — Isabel Hageman (opinion) [Ep 3 · 2:46](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=166)
- "Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional." — Isabel Hageman (clinical) [Ep 3 · 2:54](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=174)
- "Todd has seen a big change in practice over the last decade, from giving everybody narcotics after surgery to not prescribing narcotics at all." — Todd (opinion) [Ep 3 · 3:25](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=205)
- "The median length of stay was elevated due to premature infants and children already admitted to the hospital who had inguinal hernia surgery as one reason for admission." — Isabel Hageman (clinical) [Ep 3 · 5:07](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=307)
- "Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU." — Isabel Hageman (clinical) [Ep 3 · 5:33](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=333)
- "General anesthesia was a risk factor for opioid use in general." — Isabel Hageman (clinical) [Ep 3 · 6:19](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=379)
- "The institution is moving towards more spinals only for inguinal hernia repairs." — Isabel Hageman (opinion) [Ep 3 · 6:26](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=386)
- "Matthew Mitchell in Akron has been doing cases under spinal anesthesia where patients are wide awake, don't move during surgery, don't need PACU, and go home immediately." — Todd (clinical) [Ep 3 · 6:46](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=406)
- "In very young children, spinal anesthesia is easier to perform because they don't experience the potentially traumatic aspects of being in the OR as older children might." — Isabel Hageman (opinion) [Ep 3 · 7:05](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=425)
- "The median age of patients in the study was 3 months, making spinal anesthesia ideal, especially since caution with narcotics is important in young children." — Isabel Hageman (clinical) [Ep 3 · 7:27](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=447)
- "All patients in the study were open inguinal hernia patients, not laparoscopic." — Isabel Hageman (clinical) [Ep 3 · 8:23](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=503)
- "There was no association found between length of stay and opiate use, though this may be due to the small sample size of patients who received opioids." — Isabel Hageman (clinical) [Ep 3 · 8:25](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=505)
- "The study was a retrospective audit, so groups (general anesthesia only, spinal only, or both) were determined by looking back at what patients received, not selected beforehand." — Isabel Hageman (clinical) [Ep 3 · 8:55](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=535)
- "There was no institutional education around opioid prescription at the time of the study or before." — Isabel Hageman (clinical) [Ep 3 · 9:51](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=591)
- "Two or three years before the study, the warnings around opioids and their classification level were changed in Australia, which may have influenced opioid use at RCH." — Isabel Hageman (opinion) [Ep 3 · 9:51](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=591)
- "In older populations, the theory for gender differences in opioid requirements is that males are reluctant to report pain while females will ask for painkillers." — Isabel Hageman (opinion) [Ep 3 · 10:50](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=650)
- "In the very young study population where there is no verbal communication about pain, it is especially interesting that females have higher opioid requirements, and the reason is unclear." — Isabel Hageman (opinion) [Ep 3 · 11:12](https://library.globalcastmd.com/watch/paps-perioperative-opioid-use-in-paediatric-inguinal-hernia-patients-a-systematic-review-and-retrospective-audit-of-practice-isabel-hageman-5424?t=672)
- "Acetaminophen (Tylenol) plus NSAIDs (e.g., ibuprofen/Motrin) are equally as effective as narcotics for pain relief without the side effects of headache, constipation, and nausea." (clinical) [Ep 1 · 0:43](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=43)
- "5% of children will become long-term opioid users if they are given opioids, according to research by Kelly Harbaugh at the speaker's institution." (epidemiological) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- "The problem of pediatric opioid use exists not just with surgeons but also with dentists and all kinds of healthcare providers." (epidemiological) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- "Subsequent opioid prescriptions children receive are not necessarily from the surgeon who gave the first prescription." (epidemiological) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- "Excess opioids given to patients are probably the biggest entry point for narcotics into our system and subsequent abuse." (opinion) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- "Parents keep leftover opioid prescriptions, which then leak into society." (epidemiological) [Ep 1 · 1:14](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=74)
- "The most common reason for house burglaries now is those seeking drugs left over in drawers or medicine cabinets." (epidemiological) [Ep 1 · 2:42](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=162)
- "A decade ago, the IOM (Institute of Medicine) was telling clinicians they weren't adequately managing people's pain." (host_summary) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- "Consumption of hydrocodone increased 200% and oxycodone increased 500%." (host_summary) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- "Opioid deaths have quadrupled." (host_summary) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- "Pediatric hospitalizations and emergency ward visits related to opioids have doubled." (host_summary) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- "Most pediatric opioid-related hospitalizations and emergency visits are a result of prescribed medications." (host_summary) [Ep 1 · 4:07](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=247)
- "After stopping routine narcotic prescriptions for hernias and appendectomies, the speaker has not had one single patient call complaining about pain management." (clinical) [Ep 1 · 5:20](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=320)
- "Most urban areas now have traces of opioids in their water supply because so many people flush medications down the toilet." (epidemiological) [Ep 1 · 7:21](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=441)
- "Children have presented with bad toxic reactions after swallowing fentanyl patches, mistaking them for candy or gum." (clinical) [Ep 1 · 7:21](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=441)
- "Michigan has a network (Michigan Open/opiate network) that conducts drives at high schools throughout the state where parents or patients bring opiates for collection, removing immense amounts of opiates from the system." (epidemiological) [Ep 1 · 7:50](https://library.globalcastmd.com/watch/opioid-over-prescription-practice-gap-discussion-at-update-course-2018-343?t=470)
- "The intervention was based on IV Tylenol, directed post-operative pain education seminars for related faculty and staff, and standardized post-surgical sign out." — David Grabski (clinical) [Ep 4 · 0:17](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=17)
- "The study included 250 children under 1 year old who underwent non-emergent abdominal surgery in either the NICU or the acute care floor." — David Grabski (clinical) [Ep 4 · 1:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=60)
- "The intervention reduced post-operative opiate use by 98% in the study population." — David Grabski (clinical) [Ep 4 · 2:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=120)
- "In the pre-intervention cohort, the median postoperative morphine equivalence for Black children was 13 mg per kilogram, while for White children it was 2 mg per kilogram, and for Hispanic children it was 3.5 mg per kilogram." — David Grabski (epidemiological) [Ep 4 · 2:30](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=150)
- "Black children received a sixfold increase in post-operative opiate use compared to their White peers in the pre-intervention cohort." — David Grabski (epidemiological) [Ep 4 · 3:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=180)
- "In the post-intervention cohort, the median postoperative morphine equivalence in Black children reduced to just above 0 mg per kilogram, while for White children it was 0.05 mg per kilogram, and for Hispanic children it was 0.1 mg per kilogram, with these findings being statistically equivalent." — David Grabski (clinical) [Ep 4 · 3:20](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=200)
- "There was no statistical difference in demographic or clinical variables in the pre-intervention or post-intervention cohort when analyzed by race." — David Grabski (epidemiological) [Ep 4 · 4:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=240)
- "The type of surgery performed in each cohort was proportionally equivalent by race." — David Grabski (epidemiological) [Ep 4 · 4:20](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=260)
- "There was no difference in postoperative pain scores in any racial group." — David Grabski (clinical) [Ep 4 · 4:30](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=270)
- "The median total length of stay for Black children in the pre-intervention cohort was 45 days, while for White children it was 16 days." — David Grabski (epidemiological) [Ep 4 · 4:40](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=280)
- "Following the intervention, the total length of stay for Black children was 8 days, which was identical to White children." — David Grabski (clinical) [Ep 4 · 5:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=300)
- "A racial disparity was found in the pre-intervention cohort in length of post-operative intubation and TPN usage, both of which were eliminated following the clinical protocol." — David Grabski (clinical) [Ep 4 · 5:15](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=315)
- "Preliminary data suggests there might be a disparity in regional anesthesia use." — David Grabski (opinion) [Ep 4 · 5:42](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=342)
- "Standardization at all levels (pre-surgery, surgery, post-surgery, and throughout the NICU phase) was critical to the work." — David Grabski (opinion) [Ep 4 · 6:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=360)
- "Socioeconomic status associated with race was likely significant in the disparity." — David Grabski (opinion) [Ep 4 · 7:12](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=432)
- "Parents at bedside help with consoling and driving care, and that level of presence in the NICU was probably important." — David Grabski (opinion) [Ep 4 · 7:40](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=460)
- "At UVA during the study and at Lurie Children's currently, PRNs are often delivered by bedside nurses." — David Grabski (clinical) [Ep 4 · 8:00](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=480)
- "At UVA, the NAS pain score was used and if it reached a threshold, a PRN (usually fentanyl) was delivered." — David Grabski (clinical) [Ep 4 · 8:20](https://library.globalcastmd.com/watch/david-grabski-md-best-of-the-best-in-pediatric-surgery-2024-8020?t=500)
- "The opioid crisis was identified as the most important practice gap and was very popular at the APSA conference in 2018." (host_summary) [Ep 2 · 0:00](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=0)
- "The first recommendation is to reduce the total amount of opioids prescribed." — Alex (guideline) [Ep 2 · 0:21](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=21)
- "Studies show that opioids are not needed for incision and drainages or for breast biopsies." — Alex (clinical) [Ep 2 · 0:21](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=21)
- "The second recommendation is to use non-opioid analgesics, which work really well in kids." — Alex (guideline) [Ep 2 · 0:40](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=40)
- "Tylenol plus NSAIDs like Motrin are equally as effective as narcotics in children." — Alex (clinical) [Ep 2 · 0:40](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=40)
- "The third recommendation is to use non-pharmacological approaches including heat or warmth, meditation, and deep breathing, which significantly reduce pain." — Alex (guideline) [Ep 2 · 1:00](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=60)
- "The fourth recommendation is to educate patients on the disposal of unused drugs." — Alex (guideline) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=80)
- "Unused opioid drugs are staying at home and being found by kids or other family members, contributing to the opioid epidemic." — Alex (epidemiological) [Ep 2 · 1:20](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=80)
- "Pediatric surgeons can contribute to identifying practice gaps by emailing think@apsa.org." — Ray (guideline) [Ep 2 · 1:56](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=116)
- "Worldwide participation in identifying practice gaps and education efforts will lead to drastic change." — Ray (opinion) [Ep 2 · 1:56](https://library.globalcastmd.com/watch/addressing-the-opioid-crisis-2018-pediatric-surgery-practice-gap-1-1471?t=116)

## Changelog
- Sep 25: 4 items added automatically

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