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Perioperative opioid use in paediatric inguinal hernia patients: A systematic review and retrospective audit of practice

  • Isabel C. Hageman
    Correspondence
    Corresponding author at: Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia.
    Affiliations
    Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia

    Faculty of Medicine, Utrecht University, Utrecht, the Netherland
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  • Melissa Y. Tien
    Affiliations
    Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia
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  • Misel Trajanovska
    Affiliations
    Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia

    Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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  • Greta M. Palmer
    Affiliations
    Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia

    Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia

    Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia
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  • Sebastian J. Corlette
    Affiliations
    Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia

    Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia

    Department of Anaesthesia and Pain Management, The Royal Children's Hospital, Parkville, Victoria, Australia
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  • Sebastian K. King
    Affiliations
    Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria 3052, Australia

    Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia

    Department of Paediatric Surgery, The Royal Children's Hospital, Parkville, Victoria, Australia
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      Highlights

      • Opioids are frequently used in pediatric postoperative pain management.
      • In children, patterns of use and analgesic efficacy of opioids are not well established.
      • There is large variability in opioid prescribing practices after inguinal hernia repair in children.
      • Neuraxial techniques reliably reduce opioid requirements.

      Abstract

      Background

      Opioids play a major role in postoperative pain management in children, but their administration remains an under investigated topic. This study aimed to describe perioperative opioid prescribing practices for paediatric inguinal hernia patients in the literature and at The Royal Children's Hospital (RCH) in Melbourne, Australia.

      Material/method

      A systematic review of English articles (published from 2009 to 2019) was conducted on paediatric (0–18y) inguinal hernia patients who received a postoperative or discharge opioid prescription, or both. The review was combined with a retrospective audit of RCH patients. Demographic, surgical, and analgesic details were collected from the electronic medical records.

      Results

      Fifteen studies (n = 1166; combined mean age 4.93y) met the systematic review criteria. The percentage of patients receiving opioids postoperatively overall ranged from 3.33–100%, and doses ranged from 0.07 to 0.35 mg/kg oMEDD. At the RCH, perioperative opioid use was analyzed from 150 inguinal hernia patients (male – 113, median age – 3 months old). Postoperatively, 26 (17.3%) patients received opioids. The most commonly administered opioids were fentanyl (0.04–0.60 mg/kg oMEDD) in the post anaesthesia care unit and oxycodone (0.14–0.40 mg/kg oMEDD) in the first 24 h postoperatively. Older age at surgery, female sex and absence of regional anaesthesia were significantly associated with higher risk of total opioid use. No patients received an opioid prescription at discharge.

      Conclusion

      There is demonstratable variability in opioid prescribing practices for paediatric inguinal hernia patients as described in the literature. At our institution opioids were not used frequently in postoperative period.

      Keywords

      Abbreviations:

      ANZCA (Australian and New Zealand College of Anaesthetists), ASA (American Society of Anesthesiology), CI (confidence interval), ED (Emergency Department), ESPA (European Society for Paediatric Anaesthesiology), h (hour(s)), IV (intravenous), kg (kilogram), mg (milligram), μg (microgram), oMEDD (oral morphine equivalent daily dose), OR (odds ratio), PACU (post anaesthesia care unit), PO (per os (orally)), PRISMA (Preferred Reporting Items for Systematic Reviews and Meta Analysis), RCH (Royal Children's Hospital), RCT (randomised controlled trial), USA (United States of America), WHO (World Health Organisation), y (years)
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