I honestly find that super interesting because this is such a young population. So it's interesting to see that even in this young population, females have higher opioid dose requirements than males
PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman
▶Ep 12 · 0:33
clinicalOpioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients.↗
▶Ep 12 · 0:40
guidelineThere are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults.↗
▶Ep 12 · 0:52
clinicalThe study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne.↗
▶Ep 12 · 0:58
clinicalPatients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids.↗
▶Ep 12 · 1:41
clinical20% of patients received opioids intraoperatively, which was mostly fentanyl.↗
▶Ep 12 · 1:46
clinicalPost-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter.↗
▶Ep 12 · 1:53
clinical33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids.↗
▶Ep 12 · 2:02
clinicalNo patients received an opiate prescription at discharge.↗
▶Ep 12 · 2:06
clinicalIncreasing age increased the risk for postoperative and total opiate use.↗
▶Ep 12 · 2:06
clinicalThere was a significant association between female sex and total opioid use.↗
▶Ep 12 · 2:16
clinicalPreoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids.↗
▶Ep 12 · 2:23
clinicalAddition of regional blocks significantly lowered postoperative opiate use.↗
▶Ep 12 · 2:23
clinicalGeneral anesthesia was found to be a risk for total, but not postoperative opioid use.↗
▶Ep 12 · 2:33
opinionOpioids play a limited role in the pain regimens at the RCH contrary to other parts of the world.↗
▶Ep 12 · 2:46
opinionThere was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients.↗
▶Ep 12 · 2:54
clinicalPatients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional.↗
▶Ep 12 · 5:07
clinicalThe 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.↗
▶Ep 12 · 5:33
clinicalElective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU.↗
▶Ep 12 · 6:19
clinicalGeneral anesthesia was a risk factor for opioid use in general.↗
▶Ep 12 · 6:26
opinionThe institution is moving towards more spinals only for inguinal hernia repairs.↗
▶Ep 12 · 7:05
opinionIn 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.↗
▶Ep 12 · 7:27
clinicalThe median age of patients in the study was 3 months, making spinal anesthesia ideal, especially since caution with narcotics is important in young children.↗
▶Ep 12 · 8:23
clinicalAll patients in the study were open inguinal hernia patients, not laparoscopic.↗
▶Ep 12 · 8:25
clinicalThere 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.↗
▶Ep 12 · 8:55
clinicalThe 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.↗
▶Ep 12 · 9:51
clinicalThere was no institutional education around opioid prescription at the time of the study or before.↗
▶Ep 12 · 9:51
opinionTwo 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.↗
▶Ep 12 · 10:46
quoteI honestly find that super interesting because this is such a young population. So it's interesting to see that even in this young population, females have higher opioid dose requirements than males↗
▶Ep 12 · 10:50
opinionIn older populations, the theory for gender differences in opioid requirements is that males are reluctant to report pain while females will ask for painkillers.↗
▶Ep 12 · 11:12
opinionIn 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.↗
