Abstract

BACKGROUND
Interindividual variability in pain perception and analgesic response is a major problem in perioperative practice. Adult studies suggest pain management is influenced by patient's race. The objective of this study is to evaluate the influence of race on perioperative pain treatment in children.
METHODS
Prospective observational study evaluating effect of race on analgesia and opioid related adverse effects after tonsillectomy in African American and Caucasian children. A sample of 194 healthy children between 6 and 15 years of age were included. Race was self-identified by parents. All participants received standard perioperative care with a standard anesthetic and an intraoperative dose of morphine. Analgesia outcomes included maximum postoperative pain scores, postoperative opioid requirement, and analgesic interventions. Safety outcomes included incidences of opioid related adverse effects.
RESULTS
African American children experienced significantly more postoperative pain than Caucasian children as measured by postoperative opioid requirement (P = .0011), maximum postoperative pain scores (P < .0001), and analgesic interventions (P < .0001) in the recovery room. Although Caucasian children received relatively less opioids perioperatively, they had significantly higher opioid related adverse effects (P = .039). African American children with obstructive sleep apnea were more likely to have prolonged post anesthesia recovery unit stay due to inadequate pain control.
CONCLUSIONS
After similar uses of intraoperative morphine for tonsillectomy, there was an unequal burden of increased pain in African American children and increased opioid adverse effects in Caucasian children in the recovery room. Though Caucasian children received relatively less opioids perioperatively, they had higher incidences of opioid related adverse effects than African American children.

Links

PMC Free PDF

Publisher Full Text

Authors

Sadhasivam S, Chidambaran V, Ngamprasertwong P, Esslinger HR, Prows C, Zhang X, Martin LJ, McAuliffe J

Institution

Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA. senthilkumar.sadhasivam@cchmc.org

Source

Pediatrics 129:5 2012 May pg 832-8

MeSH

Adolescent
African Americans
Analgesics, Opioid
Child
Dose-Response Relationship, Drug
Ethnic Groups
European Continental Ancestry Group
Female
Healthcare Disparities
Humans
Male
Morphine
Pain Management
Pain, Postoperative
Patient Safety
Sleep Apnea, Obstructive
Tonsillectomy

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

22529273