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An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
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Prolonged opioid use after surgery in children, adolescents, and young adults: a systematic review

Naiyi Sun1, Apala Roy Chowdhury2, Anni Wu3

  • 1Department of Anesthesia and Pain Medicine, The Hospital for Sick Children (SickKids), University of Toronto, 555 University Ave., Toronto, ON, M5G 1X8, Canada. naiyi.sun@sickkids.ca.

Canadian Journal of Anaesthesia = Journal Canadien D'Anesthesie
|March 24, 2025
PubMed

Insights

Prolonged postoperative opioid use (POUS) affects 4.5% of pediatric and young adult surgical patients. Key risk factors include older age, female sex, chronic pain history, and prior opioid use.

Area of Science:

  • Pain Management
  • Pediatric Surgery
  • Pharmacology

Background:

  • Opioid analgesics are commonly prescribed for acute postsurgical pain.
  • Studies indicate a significant risk of prolonged opioid use after surgery (POUS) in both adult and pediatric populations.
  • Identifying POUS rates and risk factors in younger populations is crucial for effective pain management strategies.

Purpose of the Study:

  • To systematically review and synthesize the rates of prolonged postoperative opioid use (POUS) in children, adolescents, and young adults.
  • To identify patient-level risk factors associated with the development of POUS in these age groups.

Main Methods:

  • A systematic literature search was conducted across MEDLINE, Embase, and CINAHL databases.
  • Included studies were prospective or retrospective observational studies of pediatric or young adult patients undergoing any surgical procedure.
  • Risk of bias was assessed using an adapted Scottish Intercollegiate Guideline Network checklist, and a best-evidence synthesis was employed for risk factor assessment.

Main Results:

  • The systematic review included 17 studies encompassing 1,576,515 participants.
  • The estimated median rate of prolonged postoperative opioid use (POUS) in children, adolescents, and young adults was 4.5%.
  • Identified patient-level risk factors for POUS included older age, female sex, a history of chronic pain, and preoperative opioid use.

Conclusions:

  • Four key patient-level predictors for prolonged postoperative opioid use (POUS) were identified in pediatric and young adult surgical patients.
  • Clinicians should proactively identify patients with these risk factors before surgery.
  • Implementing targeted strategies to mitigate POUS risk is recommended for at-risk individuals.
Abstract

Keywords:
childrenopioids analgesicspostsurgeryprolonged useyoung adults

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