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
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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.
