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The association of intraoperative opioid dose with postanesthesia care unit outcomes in children: a retrospective

Michael R King1, Elizabeth De Souza2, Thomas A Anderson2

  • 1Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA. micking@luriechildrens.org.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|November 3, 2023
PubMed

Insights

Lower intraoperative opioid doses in children did not worsen postoperative pain. Instead, it led to fewer antiemetics and more nonopioid analgesics, suggesting a safe alternative for pediatric pain management.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • The impact of intraoperative opioid dosage on pediatric postoperative outcomes remains unclear.
  • Optimizing pain management while minimizing opioid exposure in children is a significant clinical challenge.

Purpose of the Study:

  • To investigate the association between intraoperative opioid dose and postoperative pain scores in the postanesthesia care unit (PACU).
  • To evaluate the relationship between intraoperative opioid dose and the need for postoperative opioid and antiemetic medications.

Main Methods:

  • A retrospective cohort study included 3,733 pediatric patients (<19 years) undergoing specific procedures under general anesthesia.
  • Patients were stratified into quartiles based on intraoperative opioid dose.
  • Multivariable regression analysis adjusted for potential confounders; an exploratory analysis of opioid-free anesthetics was also conducted.

Main Results:

  • No significant differences in PACU pain scores or length of stay were observed across intraoperative opioid dose quartiles.
  • Higher opioid dose quartiles were associated with increased antiemetic use.
  • Patients receiving the lowest opioid doses were administered more intraoperative nonopioid analgesics.

Conclusions:

  • Lower intraoperative opioid administration in children is not associated with worse PACU pain outcomes.
  • Reduced opioid doses may be feasible with concurrent use of nonopioid analgesics.
  • This approach may decrease the need for antiemetics postoperatively.
Abstract

Keywords:
anesthesia adjuvantsgeneral anesthesiaopioid analgesicspostoperative pain

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