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Pain
Everything in the library about pain — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Acute Management
1 item
Addressing the Opioid Crisis: 2018 Pediatric Surgery Practice Gap #1
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Drs. Todd Ponsky, Alex Casar, Alex Gibbons, and Rae Hanke review 2018 Practice Gap #1: Addressing the Opioid Crisis, as identified by the APSA Professional Development Committee.
video · Jun 2019
Evidence & Research
2 items
PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman
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Listen to Isabel Hageman gave her presentation of "Perioperative Opioid Use In Pediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice" at the first ever Best of the Best in Pediatric Surgery event.
video11:59 · May 2022
David Grabski, MD - Best of the Best in Pediatric Surgery 2024
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Watch APSA's Dr. David Grabski’s presentation on “Post-Operative Opioid Reduction Protocol Reduces Racial Disparity of Clinical Outcome in Children” at the 2024 Best of the Best in Pediatric Surgery event!
Moderators: Todd Ponsky, Cecili
video9:15 · Feb 2024
Case-Based Learning
1 item
Opioid over prescription: Practice Gap discussion at Update Course 2018
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At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discussthe top ten practice gaps of 2018. Here they discuss the number one practice gap, opioid over prescription, focused on interventio
video8:27 · Sep 2018
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman
Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients.
clinicalIsabel Hageman0:33 ↗
There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults.
guidelineIsabel Hageman0:40 ↗
The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne.
clinicalIsabel Hageman0:52 ↗
Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids.
clinicalIsabel Hageman0:58 ↗
20% of patients received opioids intraoperatively, which was mostly fentanyl.
clinicalIsabel Hageman1:41 ↗
Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter.
clinicalIsabel Hageman1:46 ↗
33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids.
clinicalIsabel Hageman1:53 ↗
No patients received an opiate prescription at discharge.
clinicalIsabel Hageman2:02 ↗
Increasing age increased the risk for postoperative and total opiate use.
clinicalIsabel Hageman2:06 ↗
There was a significant association between female sex and total opioid use.
clinicalIsabel Hageman2:06 ↗
Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids.
clinicalIsabel Hageman2:16 ↗
Addition of regional blocks significantly lowered postoperative opiate use.
clinicalIsabel Hageman2:23 ↗
General anesthesia was found to be a risk for total, but not postoperative opioid use.
clinicalIsabel Hageman2:23 ↗
Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world.
opinionIsabel Hageman2:33 ↗
There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients.
opinionIsabel Hageman2:46 ↗
Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional.
clinicalIsabel Hageman2:54 ↗
Todd has seen a big change in practice over the last decade, from giving everybody narcotics after surgery to not prescribing narcotics at all.
opinionTodd3:25 ↗
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.
clinicalIsabel Hageman5:07 ↗
Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU.
clinicalIsabel Hageman5:33 ↗
General anesthesia was a risk factor for opioid use in general.
clinicalIsabel Hageman6:19 ↗
The institution is moving towards more spinals only for inguinal hernia repairs.
opinionIsabel Hageman6:26 ↗
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.
clinicalTodd6:46 ↗
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.
opinionIsabel Hageman7:05 ↗
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.
clinicalIsabel Hageman7:27 ↗
All patients in the study were open inguinal hernia patients, not laparoscopic.
clinicalIsabel Hageman8:23 ↗
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.
clinicalIsabel Hageman8:25 ↗
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.
clinicalIsabel Hageman8:55 ↗
There was no institutional education around opioid prescription at the time of the study or before.
clinicalIsabel Hageman9:51 ↗
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.
opinionIsabel Hageman9:51 ↗
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.
opinionIsabel Hageman10:50 ↗
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