Opioids May Not Be Necessary After Many Common Pediatric Surgeries

A child in a hospital bed
A child in a hospital bed
The prescribing of opioids to children may not be necessary after a number of common surgeries.

The prescribing of opioids to children may not be necessary after a number of common surgeries, according to a study published in JAMA Surgery.

Opioid-related overdoses in children and adolescents rose by 250% from 1999 to 2016. Although opioids are frequently indicated to manage acute postsurgical pain, little is known about the frequency and doses at which opioids are prescribed after pediatric surgery.  

This study was part of a multispecialty quality improvement project conducted at the University of Michigan in an effort to reduce opioid prescribing. Patients <18 years who were scheduled to undergo adenoidectomy, laparoscopic appendectomy, percutaneous pinning for elbow fracture (supracondylar, epicondylar, or condylar), inguinal herniorrhaphy and/or hydrocelectomy, umbilical or epigastric herniorrhaphy, circumcision, or scrotal-incision orchiopexy at a tertiary care facility between April 2018 and November 2018 were screened for eligibility. Participants were excluded if they were currently enrolled in another study, if they were admitted for >7 days, or if they had undergone other operations prior to or concurrent with the study period.

Caregivers of participants were asked to record postoperative analgesic use in pain journals and to report use of analgesics and pain intensity, 7 to 21 days after the surgery by email, telephone, or at a follow-up appointment. Missing responses (<9%) were excluded on a question-by-question basis. Postdischarge prescriptions, pain control, and pain-related emergency department visits were examined for patients with and without opioid prescriptions.

A total of 404 caregivers (60%) of 675 eligible participants (73% boys; median age, 4 years, 25th to 75th percentile, 1-7) responded. In this cohort, 88 patients (22%) were given a discharge opioid prescription with a median of 10 doses (25th to 75th percentile, 6-15), and among the 78 respondents in that group, opioids were used for a median of 2 days (25th to 75th percentile, 1-3). Nearly all participants used fewer opioids than were prescribed (90%; n=70), with most participants using less than half (37%; n=29) or none (31%; n=24) of the opioid prescription.

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Of 403 respondents, 329 reported good pain control (82%), 56 reported adequate pain control (14%), and 18 reported poor pain control (4%). There were 3 emergency department visits for pain (0.7%), 2 of which were for post appendectomy constipation (in patients not prescribed opioids), and one for post-circumcision urinary retention. Having no opioid prescription at discharge was not found to be associated with poor pain control.

The highest opioid use was seen in elbow fracture, circumcision, and orchiopexy, but only 1 in 3 of these patients reported using opioid medication. Study limitations include its nonrandomized design.

“Given the iatrogenic risks of excess opioid, these findings suggest that safe opioid stewardship necessitates elimination of opioid exposure after many common children’s operations,” concluded the study authors.

Disclosure: This study was supported by Blue Cross Blue Shield of Michigan. Please see the original reference for a full list of authors’ disclosures.

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Harbaugh CM, Vargas G, Streur CS, et al. Eliminating unnecessary opioid exposure after common children’s surgeries [published online September 4, 2019]. JAMA Surg. doi: 10.1001/jamasurg.2019.2529