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Evaluation of Opioid Administrations After Laparoscopic Appendectomy in Pediatrics With Perforated Versus
Rachel Branton1, Elizabeth Farrington1
1Department of Pharmacy (RMB, EAF), Novant Health New Hanover Regional Medical Center, Wilmington, NC.
Insights
Perforated appendicitis patients undergoing laparoscopic appendectomy required similar opioid doses but used more acetaminophen and NSAIDs compared to non-perforated cases. This suggests a need for enhanced non-opioid pain management in complicated appendicitis.
Area of Science:
- Pediatric Surgery
- Pain Management
- Gastroenterology
Background:
- Laparoscopic appendectomy is standard for appendicitis.
- Multimodal pain management is crucial for postoperative recovery.
- Data comparing analgesic needs in perforated vs. non-perforated appendicitis are limited.
Purpose of the Study:
- To compare opioid administrations between perforated and non-perforated appendicitis after laparoscopic appendectomy.
- To determine if perforation necessitates increased opioid analgesia.
Main Methods:
- Retrospective cohort study of pediatric patients.
- Inclusion of patients undergoing laparoscopic appendectomy for perforated and non-perforated appendicitis.
- Evaluation of opioid, acetaminophen, and NSAID administrations using statistical tests.
Main Results:
- Opioid administration rates were similar (50% perforated vs. 56.7% non-perforated).
- Perforated appendicitis patients received significantly more acetaminophen (median 2.5 vs. 1) and NSAIDs (median 8 vs. 1).
- Opioid administrations increased with age in perforated cases (11% per year).
Conclusions:
- Opioid requirements were comparable between perforated and non-perforated appendicitis.
- Perforated appendicitis patients utilized significantly more non-opioid analgesics, specifically acetaminophen and NSAIDs.
Objective:
Laparoscopic appendectomy is the primary treatment of appendicitis, but multimodal pain regimens are necessary to improve postoperative outcomes and optimize pain control. There are limited data comparing the analgesic requirements between perforated and non-perforated appendicitis and whether perforation requires more opioids due to its complications. The objective of this research is to compare the quantity of opioid administrations in perforated and non-perforated appendicitis following laparoscopic appendectomy to see if there is a difference in analgesic requirements.
Methods:
This retrospective, cohort study included pediatric patients that underwent laparoscopic appendectomy for perforated and non-perforated appendicitis. Patients were evaluated from May 4, 2024 through December 31, 2024. The number of administrations of opioids, acetaminophen, and non-steroidal anti-inflammatory drugs were evaluated with binary χ2 test and Mann-Whitney U test.
Results:
A total of 60 patients were included, with 30 perforated appendicitis and 30 non-perforated appendicitis. Opioids were administered in 50% of perforated and 56.7% of non-perforated appendicitis patients (p = 0.79). A negative binomial regression showed perforated patients administered opioids received 1.58 times the number of opioid administrations on average (p = 0.19) and for each additional year of age, the expected number of opioid administrations increased by 11% (p = 0.05). The median number of non-opioid analgesic administrations were statistically significant in perforated appendicitis patients versus non-perforated, with 2.5 acetaminophen administrations versus 1 (p = 0.002) and 8 NSAID administrations versus 1 (p < 0.001).
Conclusions:
The number of opioids administered were similar across groups, but perforated appendicitis patients utilized more acetaminophen.
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