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Opioid stewardship in pediatric surgery: Approaching zero
Thais Calderon1, Elizabeth Hedges2, Michael H Livingston3
1University of Rochester School of Medicine and Dentistry, Rochester, NY.
Insights
Most children achieve adequate pain control after surgery with non-opioid medications. This study suggests limiting opioid prescriptions at discharge can reduce community opioid use while maintaining patient comfort.
Area of Science:
- Pediatric Surgery
- Pain Management
- Public Health
Background:
- The opioid epidemic necessitates reduced opioid prescribing.
- Hypothesis: Adequate pain control is achievable post-pediatric surgery with minimal discharge opioid prescriptions.
Purpose of the Study:
- To evaluate the efficacy of non-opioid pain management post-pediatric surgery.
- To assess the impact of limited opioid discharge prescriptions on pain control and patient outcomes.
Main Methods:
- Retrospective cohort study of pediatric patients (0-15 years) undergoing surgery.
- Data collected on opioid prescriptions, emergency department visits, and readmissions.
- Postoperative pain assessed via phone calls within three days of discharge.
Main Results:
- 352 patients (394 procedures) reviewed; only 3 received opioid discharge prescriptions.
- No pain-related readmissions; one emergency department visit for pain.
- Most patients reported low pain scores (59% reported 0, 27% reported 1-3).
- Higher pain scores correlated with increased age; hernia repair patients reported low pain.
Conclusions:
- Non-opioid medications effectively manage pain for most pediatric surgical patients at discharge.
- A small subset may benefit from limited opioid analgesia.
- This approach can significantly decrease community opioid prevalence.
Introduction:
In response to the opioid epidemic, we hypothesized that adequate pain control can be achieved with few, if any, opioid prescriptions at discharge following pediatric surgical procedures.
Methods:
All records for patients 0-15 years old who underwent pediatric surgical operations from December 2017 through May 2018 were reviewed. Opioids prescriptions, emergency department (ED) visits, and hospital readmissions were recorded. Postoperative pain was assessed on a scale from 0 to 10 via phone call within three days of discharge.
Results:
352 patients underwent 394 surgical procedures. Three patients were prescribed opioids at discharge. There were no pain-related readmissions. One patient returned to the ED owing to pain. 116 unique pain scores were obtained from 114 patients: score 0 (n = 69, 59%), 1-3 (n = 31, 27%), 4-5 (n = 11, 9%), 6-8 (n = 5, 4%), and 9-10 (n = 0, 0%). There was a positive association between pain and increasing age (r = 0.26, p = 0.005). No patients who underwent hernia repair reported a pain score greater than 3.
Conclusions:
Adequate pain control at discharge after pediatric general surgical procedures can be achieved for most children with scheduled nonopioid medications only. A limited supply of opioids for analgesia after discharge may benefit small subset of patients. This strategy would help reduce opioid prevalence in the community.
Type Of Study:
Retrospective cohort study.
Level Of Evidence:
Level III.
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