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Children's Opioid Use at Home After Laparoscopic Appendectomy
Renee C B Manworren1, Naomi Kaduwela2, Trishla Mishra2
1Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois; Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Insights
Medication adherence technology (eCAP) offers a more accurate way to track pediatric opioid use after surgery compared to self-reports. This technology helps estimate needs and detect potential misuse in children.
Area of Science:
- Pediatric Surgery
- Pain Management
- Pharmacology
Background:
- Accurate pediatric home opioid requirement data is crucial for managing acute post-surgical pain.
- Current estimates rely on retrospective surveys, highlighting a need for more precise methods.
- Medication adherence technology (eCAP) was employed to track actual home opioid consumption.
Purpose of the Study:
- To detail pediatric pain management at home following laparoscopic appendectomy.
- To compare self-reported opioid analgesic use against eCAP data and returned pill counts.
- To assess the accuracy of different methods in quantifying post-operative opioid consumption.
Main Methods:
- A prospective, exploratory, and descriptive study design was utilized.
- 96 pediatric patients (10-17 years) undergoing laparoscopic appendectomy participated.
- Data collection involved 14-day self-report diaries and eCAP monitoring of prescribed opioid use.
Main Results:
- Patients received a mean of 15 ± 7.2 opioid pills; significant differences were found between pill count (6.6 ± 6.3) and self-report (5.6 ± 5.1) usage (p=0.004).
- Of dispensed pills, a substantial portion was returned (488) or missing (53.5), with only 167.5 used as prescribed.
- Opioid-naïve patients (72%) predominantly used opioids on weekends, indicated by eCAP-recorded bottle openings.
Conclusions:
- Medication adherence technology (eCAP) provides a more rigorous and accurate method for estimating pediatric opioid needs than self-reporting.
- eCAP aids in the early detection of potential opioid misuse in pediatric populations.
- Further rigorously designed studies are necessary to refine opioid prescribing guidelines for post-operative pediatric pain management.
Background:
To combat the opioid epidemic, prescribers need accurate information about pediatric home opioid requirements to manage acute pain after surgery. Current opioid use estimates come from retrospective surveys; this study used medication adherence technology (eCAP) to track home opioid use.
Purpose:
To describe children's pain treatment at home after laparoscopic appendectomy, and to compare self-reported opioid analgesic use to eCAP data and counts of returned pills.
Design:
Prospective exploratory and descriptive study METHODS: A convenience sample of 96 patients, 10-17 years of age, from a single urban nonprofit children's hospital consented to self-report pain treatment in 14-day diaries and use eCAP to monitor prescribed opioid use at home after laparoscopic appendectomy.
Results:
Patients were prescribed 5-45 opioid-containing pills (mean ± standard deviation 15 ± 7.2). Of 749 opioid-containing pills prescribed to 49 patients who returned data, 689 pills were dispensed, 167.5 were used for the reason prescribed, 488 were returned to families for disposal, and 53.5 were missing. The majority of the 49 patients were opioid naïve (72%), Caucasian (64%), and male (56%), with a mean age of 14 years. Patients used 6.6 ± 6.3 opioid-containing pills by pill count and 5.6 ± 5.1 by self-report, a significant difference (p = .004). Unreported eCAP-enabled pill bottle openings typically occurred on weekends.
Conclusion:
Medication adherence technology (eCAP) is a more rigorous method than self-report to estimate opioid needs and detect early opioid misuse. Additional rigorously designed studies of postoperative opioid use are needed to guide opioid prescribing.
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