Postoperative opioids: do children need them after common surgeries?

  • JAMA Surg
  • 5 Sep 2019

  • International Clinical Digest
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Takeaway

  • Postoperative opioids are not needed to control pain in children following umbilical/epigastric herniorrhaphy, appendectomy, and other common surgeries, as long as adequate nonopioid analgesics are provided.

Why this matters

  • Nearly all patients in this study who received a postoperative opioid prescription used less than prescribed, and extra opioid medications were often kept unlocked and undisposed.

Study design

  • 675 patients (age,
  • Among the 675 eligible patients, 404 caregivers responded.
  • Funding: Blue Cross Blue Shield of Michigan.

Key results

  • A discharge opioid prescription was given to 22% of the patients (median, 10 doses; 25th-75th percentile, 6-15).
  • Acetaminophen (88%) and ibuprofen (78%) use was common.
  • Overall pain control reported was good (82%), adequate (14%), or poor (4%).
  • Lack of a discharge opioid prescription was not associated with (opioid vs no opioid):
    • poor pain control (3.4% vs 4.8%; P=.77);
    • postdischarge opioid prescription (4.6% vs 1.3%; P=.07); and
    • pain-related emergency department visit (1.1% vs 0.6%; P=.52).

Limitations

  • Single-center, nonrandomised design.

Coauthored with Chitra Ravi, MPharm