A Simple Predictor of Pediatric Opioid Requirements After Laparoscopic Appendectomy

A retrospective analysis was used to formulate an evidence-based predictor for postoperative opioid requirements in pediatric patients undergoing laparoscopic appendectomy. These findings were published in the European Journal of Pediatric Surgery.

Patients aged <16 years (N=116) who underwent laparoscopic appendectomy at the Lucerne Children’s Hospital in Switzerland between 2018 and 2019 were retrospectively reviewed for pain outcomes. A multiple logistic regression analysis was performed to identify risk factors for opioid use.

Patients were 45.7% girls, aged median 10 years (interquartile range [IQR], 8-12), with BMI of 16.4 (IQR, 14.8-19.3) kg/m².

The laparoscopic appendectomy procedure lasted an average of 65.5 (standard deviation [SD], 25.0) minutes and sonographic appendix was 9.7 (SD, 2.7) mm in diameter. Most patients were hospitalized for 2 (48.3%) or 3 (25%) days.

After the procedure, most patients (n=97) received 2 or fewer opioid doses. The patients who received more than 2 doses were more likely to have perforation (47.4% vs 9.4%; P <.001) and turbid/purulent fluid (55.6% vs 13.2%; P <.001).

In general, the patients who received more opioids were older (median, 12 vs 10 years; P =.003), had higher C-reactive protein levels (median, 108 vs 22.5 mg/dL; P =.002), and had longer duration of pain symptoms (median, 68.5 vs 30 h; P =.003).

Postoperative opioid need was associated with age (odds ratio [OR], 1.538; 95% CI, 1.172-2.018; P =.002), turbid/purulent fluid (OR, 34.179; 95% CI, 3.634-321.4; P =.002), and white blood cell count (OR, 1.130; 95% CI, 1.015-1.257; P =.025).

On the basis of these data, a predictive tool was formulated which considered age (x₁), turbid intra-abdominal fluid (x₂), white blood cell count (x₃), elevated body temperature (x₄), and symptom duration (x₅) with the constants k₀ (-8.909), k₁ (0.431), k₃ (0.122), k₄ (-1.867), and k₅ (0.0075).

The formula had a receiving operator characteristic curve area of 0.87 (95% CI, 0.79-0.93).

This study was limited by the small sample size and the lack of external validation.

“We developed an algorithm-based predictor tool that has the potential to better anticipate postoperative pain and hereby optimize pain management following laparoscopic appendectomies in children,” the study authors concluded.  All variables included in this algorithm are relatively easy to obtain, making this tool available for use by clinicians.

Reference

Unglert A-K, Lehnick D, Szavay PO, Zundel S. A novel tool to predict postoperative opioid need after laparoscopic appendectomy in children: a step toward evidence-based pain management. Eur J Pediatr Surg. Published online March 9, 2022. doi:10.1055/s-0042-1744148