Abstract
Background/purpose
This study aimed to evaluate the impact of a Pediatric Acute Pain Guideline on postsurgical
pain scores, opioid exposure, and discharge opioid prescribing habits in postappendectomy
patients.
Methods
This was a retrospective single-center quality improvement project, including patients
admitted for an appendectomy at a pediatric medical center between April 1 and December
31, 2018. Patients 0–17 years of age, who underwent a laparoscopic appendectomy without
complications, were inpatient for at least 1 calendar day, and designated as presurgical
American Society of Anesthesiologists (ASA) category 1 or 2 were included.
Results
Two hundred fifty-eight patients met inclusion criteria (n = 92 pre-, n = 166 post-guideline implementation). There was a decrease in the number of as needed
opioid doses used (p = 0.014) and length of hospitalization (p = 0.003) post-guideline
implementation compared to pre-guideline implementation. A decrease in the number
of as needed doses of opioids used (p < 0.001) and in opioid exposure (p = 0.038)
during hospitalization was also seen when the nonopioid pain agent was scheduled.
Conclusions
The implementation of the Pediatric Acute Pain Guideline was associated with a decrease
in the number of as needed opioid doses used during hospitalization, which may have
contributed to a decreased length of hospitalization. Scheduling nonopioid pain medications
decreased opioid exposure.
Level of evidence
Treatment study level III.
Abbreviations:
American Society of Anesthesiologists (ASA), Center for Disease Control and Prevention (CDC), Institutional Review Board (IRB), Pediatric Intensive Care Unit (PICU), Nonsteroidal anti-inflammatory drug (NSAID)Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Pediatric SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- U.S. opioid prescribing rate maps.https://www.cdc.gov/drugoverdose/maps/rxrate-maps.htmlDate accessed: October , 2018
- Overdose death rates.https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-ratesDate accessed: October , 2018
- US national trends in pediatric deaths from prescription and illicit opioids, 1999–2016.J Am Med Assoc. 2018; 1https://doi.org/10.1001/jamanetworkopen.2018.6558
- Opioid-related critical care resource use in US children's hospitals.Pediatr. 2018; 141https://doi.org/10.1542/peds.2017-3335
- Outpatient opioid prescriptions for children and opioid-related adverse events.Pediatr. 2018; 142https://doi.org/10.1542/peds.2017-2156
- Trends in medical and nonmedical use of prescription opioids among US adolescents: 1976–2015.Pediatr. 2017; 139https://doi.org/10.1542/peds.2016-2387
- Clinical pathway: opioid prescribing practices.Children's Hospital Colorado, Aurora, CO2017
- Veldhuyzen van Zanten S, Inglis K, et al. A randomized controlled trial comparing acetaminophen plus ibuprofen versus acetaminophen plus codeine plus caffeine after outpatient general surgery.J Am Coll Surg. 2008; 206: 472-479https://doi.org/10.1016/j.jamcollsurg.2007.09.006
- Effect of a single dose of oral opioid and nonopioid analgesics on acute extremity pain in the emergency department: a randomized clinical trial.JAMA. 2017; 318: 1661-1667https://doi.org/10.1001/jama.2017.16190
- Too much of a bad thing: discharge opioid prescriptions in pediatric appendectomy patients.J Surg Oncol. 2018; 53: 2374-2377https://doi.org/10.1016/j.jpedsurg.2018.08.034
Article Info
Publication History
Published online: October 17, 2020
Accepted:
September 30,
2020
Received in revised form:
September 22,
2020
Received:
June 5,
2020
Footnotes
☆Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
☆☆Declarations of interest: none.
Identification
Copyright
© 2020 Elsevier Inc. All rights reserved.
