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Updated: Dec 26, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
No pain is gain: A prospective evaluation of strict non-opioid pain control after pediatric appendectomy
Kristin M Gee1, R Ellen Jones1, Nicole Nevarez1
1Department of Surgery, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390.
Insights
A strict non-opioid pain control strategy using alternating acetaminophen and ibuprofen after pediatric appendectomy demonstrated high effectiveness. This approach offers a safe and successful alternative to opiate use in pediatric surgical pain management.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Opiate use in pediatric surgery is common despite safety concerns and limited evidence of superiority.
- A strict non-opioid pain control strategy is evaluated for laparoscopic appendectomy in children.
Purpose of the Study:
- To prospectively evaluate the efficacy of a non-opioid pain control strategy after pediatric laparoscopic appendectomy.
- To assess pain levels and medication usage via daily parental surveys.
Main Methods:
- 120 children undergoing laparoscopic appendectomy for acute appendicitis were enrolled.
- A standard practice of alternating over-the-counter (OTC) acetaminophen and ibuprofen was followed, with no opiate prescriptions.
- Parents completed daily surveys on postoperative days 1-5 to report pain and medication use.
Main Results:
- No patients received opiate prescriptions.
- Mean pain scores significantly decreased from 4.7 on postoperative day 1 to 0.7 on postoperative day 5.
- Parent-reported success rates for OTC pain management ranged from 85% on postoperative day 1 to 100% on postoperative days 4 and 5.
Conclusions:
- A strict non-opioid pain management strategy is highly effective for pediatric appendectomy.
- This approach shows promise as a standard of care and for application to other pediatric surgical procedures.
Introduction:
Opiates are often prescribed after pediatric operations despite safety concerns and lack of evidence confirming superiority compared to other pain control modalities. In this study, we use daily parental surveys to prospectively evaluate a strict non-opioid pain control strategy after laparoscopic appendectomy.
Methods:
After IRB approval, children who underwent laparoscopic appendectomy for nonperforated acute appendicitis were recruited to the study. For these patients, our standard practice is to provide instructions to administer alternating acetaminophen and ibuprofen over-the-counter (OTC) postoperatively, and no opiate prescriptions are written. Parents of enrolled children received a daily RedCap survey via text message or e-mail on postoperative days (POD) 1 through 5 to prospectively assess pain control and medication usage. Trends were compared across postoperative days.
Results:
One hundred twenty patients were enrolled in the study, and none received opiate prescriptions. Postoperative pain survey response rates were 54% on POD1, 47% on POD2, 35% on POD3, 34% on POD4, and 29% on POD5. Pain level was 4.7 ± 2.3 (out of 10) on POD1, and down-trended significantly each postoperative day to reach 0.7 ± 1.2 by POD5. On POD1, 85% of parents administered OTC medications, which reduced significantly to 14% by POD5. Parent-reported success rates to manage pain by OTC regimen were 85% on POD1, 94% on POD2, 91% on POD3, and 100% on POD4 and POD5.
Conclusion:
Strict non-opioid pain control after appendectomy exhibits high performance based upon prospective parental surveys. This strategy should be implemented as standard of care and tested for application to other surgical conditions.
Level Of Evidence:
Level II.
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