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Association of Opioid Quantity and Caregiver Education with Pain Control after Pediatric Tonsillectomy
Calista M Harbaugh1,2, Gracia Vargas2, Kenneth R Sloss2
1Department of Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA.
Insights
Caregiver education on using non-opioid pain relievers first significantly improved pain control after pediatric tonsillectomy. Reducing opioid prescription amounts did not impact pain management outcomes.
Area of Science:
- Pediatric Otolaryngology
- Pain Management
- Health Services Research
Background:
- Postoperative pain management after pediatric tonsillectomy often involves opioid analgesics.
- Concerns exist regarding opioid overprescription and patient safety.
- Optimizing non-opioid analgesic use is crucial for effective pain control.
Purpose of the Study:
- To evaluate the impact of a service guideline reducing opioid prescription quantities.
- To assess the association between caregiver education on non-opioid use and pain control.
- To determine factors influencing pain management post-tonsillectomy in children.
Main Methods:
- Prospective cohort study involving caregivers of pediatric tonsillectomy patients.
- Surveyed caregivers on pain control, non-opioid education, and opioid use.
- Logistic regression analyzed the association between guideline implementation, education, and pain control.
Main Results:
- Reduced mean opioid prescription doses post-guideline implementation (27 to 21 doses).
- Caregiver-reported education to use non-opioids first was associated with better pain control (aOR, 1.9; P=.02).
- Guideline implementation reducing opioid quantity was not significantly associated with improved pain control (aOR, 1.3; P=.22).
Conclusions:
- Caregiver education emphasizing non-opioid analgesics first is a key factor in improving pediatric pain control.
- This educational approach may be a modifiable practice to enhance pain management.
- Reducing opioid prescription quantities alone may not be sufficient to improve pain outcomes.
Objective:
To examine whether a service guideline reducing postoperative opioid prescription quantities and caregiver-reported education to use nonopioid analgesics first are associated with caregiver-reported pain control after pediatric tonsillectomy.
Study Design:
Prospective cohort study (July 2018-April 2019).
Setting:
Pediatric otolaryngology service at a tertiary academic children's hospital.
Subjects And Methods:
Caregivers of patients aged 1 to 11 years undergoing tonsillectomy (N = 764) were surveyed 7 to 21 days after surgery regarding pain control, education to use nonopioid analgesics first, and opioid use. Respondents who were not prescribed opioids or had missing data were excluded. Logistic regression modeled caregiver-reported pain control as a function of service guideline implementation (December 2018) recommending 20 rather than 30 doses for postoperative opioid prescriptions and caregiver-reported analgesic education, adjusting for patient demographics.
Results:
Among 430 respondents (56% response), 387 patients were included. The sample was 43% female with a mean age of 5.0 years (SD, 2.5). Pain control was reported as good (226 respondents, 58%) or adequate/poor (161 respondents, 42%). Mean opioid prescription quantity was 27 doses (SD, 7.9) before and 21 doses (SD, 6.1) after guideline implementation (P < .001). Education to use nonopioids first was reported by 308 respondents (80%). In regression, prescribing guideline implementation was not associated with pain control (adjusted odds ratio, 1.3; 95% CI, 0.9-2.0; P = .22), but caregiver-reported education to use nonopioids first was associated with a higher odds of good pain control (adjusted odds ratio, 1.9; 95% CI, 1.1-3.2; P = .02).
Conclusion:
Caregiver education to use nonopioid analgesics first may be a modifiable health care practice to improve pain control as postoperative opioid prescription quantities are reduced.
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