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Opioid use may be reduced without increasing pain in outpatient paediatric surgery

15 May 2019

A recent study suggests the feasibility of reducing opioid prescriptions without increasing pain scores in outpatient paediatric surgical practice. In addition, prescribing practices among physicians may contribute more to opioid consumption than actual pain patterns.

Of the 250 children who met the eligibility criteria, 98 (39 percent; median age, 3.0 years) participated in the study. Eighty-one patients were prescribed opioids, with a median of two doses in the pre- and postintervention groups (p=0.68).

Nonparametric statistical testing showed no significant differences between pain scores in the 5-dose group (n=31 patients) and the 10-dose group (n=24 patients; p=0.05 for day 1; p=0.07 for day 2; p=0.06 for day 3). No association was found between age and percent opioid used (p=0.83). Furthermore, no significant differences were seen in median pain scores or median doses among procedure types.

Another recent study found a significant difference in opioid prescribing practices following paediatric surgical procedures and suggested an increase in awareness to minimize this variability and reduce overprescribing. [J Surg Res 2019;241:57-62]

The present study evaluated the impact of a two-phase Plan-Do-Study-Act cycle to reduce opioid prescriptions after paediatric urological surgery. Questionnaires were handed out to parents of children undergoing outpatient urological procedures to assess opioid dosing and pain scores using the Parents’ Postoperative Pain Measure scale.

The authors recorded age, procedure, opioid prescription data and volume of medication administered. Children were given an opioid prescription for 10 doses during the first phase of data collection. In the second phase, opioid prescriptions decreased by 50 percent. Nonparametric tests and Fisher exact test were used for analysis.

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