Eliminating Opiate Prescribing for Children after Non-Perforated Appendectomy

Area of Science:

• Pediatric Surgery
• Pain Management
• Public Health

Background:

• Opiates are standard for postoperative pain but contribute to community addiction.
• Efforts to reduce opiate distribution raise concerns about inadequate pain relief.
• This study addresses the balance between reducing opiate availability and ensuring effective pain management in pediatric patients.

Purpose of the Study:

• To evaluate the impact of reducing and eliminating opiate prescriptions for children undergoing appendectomy.
• To assess postoperative pain control and medication use after intervention.
• To quantify the reduction in opiate doses prescribed and distributed.

Main Methods:

• A retrospective analysis of opiate prescriptions for pediatric appendectomy patients across three distinct time periods.
• Data collection included prescription numbers, filled prescriptions, and patient-reported pain management via phone surveys.
• Intervention phases involved standardizing and reducing, then eliminating opiate prescriptions.

Main Results:

• Opiate prescriptions decreased from 100% pre-intervention to 30% after reduction, and 1.1% after elimination.
• Mean oxycodone doses per patient dropped from 15 to 1.5, then to 0.05.
• Patients reported no pain relief issues, and no subsequent need for opiates was noted.

Conclusions:

• A stepwise elimination of post-discharge opiate use for pediatric appendectomy is feasible.
• This strategy significantly reduced community opiate exposure (4,035 doses averted) while maintaining adequate pain control.
• The findings support non-opiate-based pain management strategies in pediatric surgery.