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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 28, 2010
Procedure time-of-day effects on postoperative opioid requirements in children
Clinton L Fuller1, Maxwell Lee2, Kathleen E Hosek3
1Department of Pediatric Anesthesiology, Perioperative, and Pain Medicine, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA.
Insights
Nighttime surgery did not alter postoperative opioid needs in children. Opioid requirements remained higher during daytime hours, regardless of when the appendectomy was performed. This suggests circadian rhythm shifts do not significantly impact pain management in pediatric appendectomies.
Area of Science:
- Pediatric Surgery
- Anesthesiology
- Circadian Biology
Background:
- Postoperative pain management in children is crucial.
- Adults exhibit circadian patterns in analgesic needs, with higher requirements in the morning.
- The timing of surgery may influence circadian rhythms and subsequent pain perception.
Purpose of the Study:
- To investigate if nighttime surgery alters postoperative opioid requirements in children.
- To determine if circadian rhythm shifts affect the timing of peak opioid demand.
- To test the hypothesis that nighttime surgery leads to higher nighttime opioid needs in pediatric patients.
Main Methods:
- Retrospective cohort study of 999 children (aged 1-18) undergoing laparoscopic appendectomy for complicated appendicitis.
- Data collected between January 2018 and December 2019.
- Comparison of total, daytime, and nighttime postoperative morphine equivalents (mg/kg) between children operated during the day versus at night.
Main Results:
- Children operated at night (n=241) showed slightly higher total opioid requirements compared to those operated during the day (n=758), though this difference was not statistically significant in all measures.
- Regardless of surgery time, all children required more morphine equivalents during daytime hours than nighttime hours.
- No significant shift in the timing of peak opioid requirements was observed due to nighttime surgery.
Conclusions:
- The time of day for laparoscopic appendectomy in children with complicated appendicitis does not significantly impact postoperative opioid requirements.
- Circadian rhythm does not appear to shift opioid demand to nighttime hours following nocturnal surgery in this pediatric population.
- Daytime hours consistently show higher analgesic needs post-appendectomy, irrespective of the procedure's timing.
Purpose:
Postoperative analgesic requirements in adults follow circadian rhythm patterns with requirements for opioids and local anesthetics highest in the morning. Procedure time of day may also potentially affect circadian rhythm patterns with surgery at night promoting wakefulness during nighttime hours. This disruption may produce a shift in the circadian rhythm and potentially affect when postoperative opioid requirements are highest. We hypothesized that children undergoing surgery at night would have higher postoperative opioid requirements during nighttime hours secondary to a shift in the circadian rhythm with those requirements remaining higher than daytime requirements for the duration of the hospital stay.
Methods:
A retrospective cohort was completed on all children aged 1-18 years undergoing a laparoscopic appendectomy for complicated appendicitis between January 2018 and December 2019. Outcomes were total postoperative morphine equivalents (mg/kg), including total daytime and nighttime postoperative morphine equivalents (mg/kg) in children undergoing surgery during the day and at night.
Results:
There were 999 children who underwent a laparoscopic appendectomy for complicated appendicitis at Texas Children's Hospital from January 1, 2018 to December 31, 2019. Of these, 758 children underwent the procedure during the day and 241 children at night. The total, daytime, and nighttime median morphine equivalents (mg/kg) for children undergoing an appendectomy during the day were 0.1 (0.0-0.4), 0.0 (0.0-0.2), 0.1 (0.0-0.2), respectively. The total, daytime, and nighttime morphine equivalents (mg/kg) for children undergoing an appendectomy at night were 0.2 (0.0-0.5) (p = -0.01), 0.1 (0.0-0.3) (p = 0.01), and 0.1 (0.0-0.2) (p = 0.03), respectively. All children, irrespective of the procedure time of day, required more morphine equivalents during daytime hours than during nighttime hours.
Conclusions:
We found that procedure time of day did not impact postoperative opioid requirements in children undergoing a laparoscopic appendectomy for complicated appendicitis. Both children undergoing an appendectomy during the day or at night required more morphine equivalents during daytime hours than during nighttime hours. Surgery at night did not produce a shift in opioid requirements postoperatively from daytime hours to nighttime hours in children undergoing an appendectomy at night.
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