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A Double-blinded Randomized Controlled Trial Assessing the Efficacy of Opioid Disposal Instructions with Parental
Logan Galansky1, Manuj Shah1, Tamir Sholklapper2
1James Buchanan Brady Urological Institute, Johns Hopkins University School of Medicine, Baltimore, MD.
Insights
Standardized opioid disposal instructions and parental education did not improve proper disposal of leftover opioid medication or alter post-discharge opioid use in children after urologic surgery.
Area of Science:
- Pediatric Surgery
- Pain Management
- Public Health
Background:
- Safe disposal of leftover opioid medication is crucial for preventing misuse and environmental contamination.
- Children undergoing ambulatory urologic surgery often receive opioid prescriptions, necessitating proper disposal strategies.
- Current disposal practices may be suboptimal, highlighting the need for effective interventions.
Purpose of the Study:
- To evaluate the efficacy of standardized opioid disposal instructions coupled with parental education in improving proper disposal rates among pediatric patients.
- To compare the impact of enhanced disposal education versus routine instructions on leftover opioid management.
- To assess the effect of the intervention on postoperative pain scores and opioid utilization.
Main Methods:
- A prospective, double-blinded, randomized controlled trial involving 104 children (6-18 years) undergoing ambulatory urologic procedures.
- Participants were randomized to receive either FDA opioid disposal best practices with nursing education or routine postoperative instructions.
- Outcomes included proper opioid disposal rates, pain measures (PPPM, NPS), and opioid utilization at 10-14 days post-procedure.
Main Results:
- No significant difference in proper opioid disposal rates was observed between the intervention (31%) and control (18%) groups (P=0.1).
- The odds of proper disposal were not significantly increased with the intervention (OR 2.0; P=0.1).
- No differences were found in postoperative pain scores or opioid utilization between the groups.
Conclusions:
- Formal opioid disposal instructions with parental education did not significantly improve the proper disposal of leftover opioid medication after pediatric urologic surgery.
- The intervention did not alter post-discharge opioid utilization or pain management outcomes.
- Enhanced educational strategies may be needed to effectively promote safe opioid disposal practices in this population.
Objectives:
To determine if the administration of standardized opioid disposal instructions with focused parental education improves proper disposal of leftover opioid medication among families of children undergoing ambulatory urologic surgery compared to routine postoperative instructions.
Methods:
A prospective, double-blinded, single-center randomized controlled trial was conducted in children 6-18 years undergoing ambulatory urology procedures between October 2021 and April 2023. Patients were randomized (1:1) to receive either the Food and Drug Administration (FDA) opioid disposal best practices worksheet plus nursing parental education or routine postoperative instructions alone. All patients were prescribed acetaminophen and ibuprofen and a per-protocol rescue opioid prescription. The primary outcome was rate of proper opioid disposal at 10-14 days post-procedure. Secondary outcomes included parents' postoperative pain measure (PPPM) scores, numerical pain scale (NPS) scores, and weight-based opioid utilization at 48 hours and 10-14 days.
Results:
We randomized 104 participants (53 intervention, 51 control) with 97% (101/104) complete follow-up data at 10-14 days. Patient demographics, procedural characteristics, and analgesia use were similar between groups. We observed no significant difference in proper opioid disposal rates between arms (31% intervention vs 18% control; estimated difference in proportion 13% [95% CI, -4%-29%]; P = .1). There were no increased odds of proper disposal of leftover opioid medication at 10-14 days with the intervention compared to the control (OR 2.0 [95% CI 0.8-5.1]; P = .1). We observed no differences in PPPM scores, NPS scores, or opioid utilization at 48 hours or 10-14 days.
Conclusion:
Providing formal opioid disposal instructions with parental education did not improve proper disposal of leftover opioid medication nor did it alter post-discharge opioid utilization after pediatric urologic surgery.
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