Perioperative management of the child on long-term opioids

Area of Science:

• Pediatric Anesthesiology
• Pain Management
• Pharmacology

Background:

• Strategies for managing children on long-term opioids are often adapted from adult guidelines.
• Perioperative opioid consumption is significantly higher in children with chronic opioid use compared to others.
• Inadequate opioid management can lead to poor pain control and withdrawal symptoms in these pediatric patients.

Purpose of the Study:

• To outline effective perioperative pain management strategies for children with long-term opioid exposure.
• To emphasize the need for maintaining a child's baseline opioid requirement during surgery.
• To highlight the importance of supplemental analgesia for acute postoperative pain.

Main Methods:

• Maintaining the child's pre-existing opioid requirement using long-acting formulations (e.g., patches, pumps).
• Administering additional analgesia for acute perioperative pain, including short-acting opioids, regional/local anesthesia, and adjuvant therapies.
• Utilizing various methods for supplemental postoperative pain relief, such as intravenous infusions, nurse-controlled analgesia, patient-controlled analgesia, or oral formulations.

Main Results:

• Perioperative opioid needs are substantially elevated in children with long-term opioid use.
• A multimodal approach combining baseline maintenance and supplemental analgesia is crucial.
• Effective management necessitates collaboration among the child, family, and healthcare teams.

Conclusions:

• Pediatric perioperative pain management for children on long-term opioids requires a tailored approach, not just dose escalation.
• Acute pain services can effectively manage these patients in the perioperative setting.
• Education for staff on specific challenges and postoperative management strategies is essential for successful outcomes and discharge planning.