Tags

Type your tag names separated by a space and hit enter

Preoperative Opioids Associated With Increased Postoperative Opioid Use in Pediatric Appendicitis.
J Surg Res. 2020 Jun 16; 255:144-151.JS

Abstract

BACKGROUND

In light of current opioid-minimization efforts, we aimed to identify factors that predict postoperative opioid requirement in pediatric appendicitis patients.

METHODS

A single-center retrospective cohort study was conducted of children (<18 y) who underwent laparoscopic appendectomy for acute appendicitis between January 1, 2018 and April 30, 2019. Patients who underwent open or interval appendectomies were excluded. The primary outcome was morphine milliequivalents (MMEs) per kilogram administered between 2 and 24 h after surgery. Multivariable analyses were performed to evaluate predictors of postoperative opioid use. Clinically sound covariates were chosen a priori: age, weight, simple versus complicated appendicitis, preoperative opioid administration, and receipt of regional or local anesthesia.

RESULTS

Of 546 patients, 153 (28%) received postoperative opioids. Patients who received postoperative opioids had a longer median preadmission symptom duration (48 versus 24 h, P < 0.001) and were more likely to have complicated appendicitis (55% versus 21%, P < 0.001). Patients who received postoperative opioids were more likely to have received preoperative opioids (54% versus 31%, P < 0.001). Regional and local anesthesia use was similar between groups. Nearly all patients (99%) received intraoperative opioids. Each preoperative MME per kilogram that a patient received was associated with receipt of 0.29 additional MMEs per kilogram postoperatively (95% confidence interval, 0.19-0.40).

CONCLUSIONS

Preoperative opioid administration was independently associated with increased postoperative opioid use in pediatric appendicitis. These findings suggest that preoperative opioids may potentiate increased postoperative pain. Limiting preoperative opioid exposure, through strategies such as multimodal analgesia, may be an important facet of efforts to reduce postoperative opioid use.

Authors+Show Affiliations

McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.Children's Memorial Hermann Hospital, Houston, Texas; Department of Anesthesiology, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas.McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas.McGovern Department of Pediatric Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Center for Surgical Trials and Evidence-based Practice (C-STEP), McGovern Medical School at the University of Texas Health Science Center at Houston, Houston, Texas; Children's Memorial Hermann Hospital, Houston, Texas. Electronic address: mary.t.austin@uth.tmc.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32559522

Citation

Ferguson, Dalya M., et al. "Preoperative Opioids Associated With Increased Postoperative Opioid Use in Pediatric Appendicitis." The Journal of Surgical Research, vol. 255, 2020, pp. 144-151.
Ferguson DM, Anding CM, Arshad SA, et al. Preoperative Opioids Associated With Increased Postoperative Opioid Use in Pediatric Appendicitis. J Surg Res. 2020;255:144-151.
Ferguson, D. M., Anding, C. M., Arshad, S. A., Kamat, P. S., Bain, A. P., Cameron, S. D., Tsao, K., & Austin, M. T. (2020). Preoperative Opioids Associated With Increased Postoperative Opioid Use in Pediatric Appendicitis. The Journal of Surgical Research, 255, 144-151. https://doi.org/10.1016/j.jss.2020.05.022
Ferguson DM, et al. Preoperative Opioids Associated With Increased Postoperative Opioid Use in Pediatric Appendicitis. J Surg Res. 2020 Jun 16;255:144-151. PubMed PMID: 32559522.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Preoperative Opioids Associated With Increased Postoperative Opioid Use in Pediatric Appendicitis. AU - Ferguson,Dalya M, AU - Anding,Caroline M, AU - Arshad,Seyed A, AU - Kamat,Pranali S, AU - Bain,Andrew P, AU - Cameron,Staci D, AU - Tsao,KuoJen, AU - Austin,Mary T, Y1 - 2020/06/16/ PY - 2020/02/28/received PY - 2020/04/24/revised PY - 2020/05/03/accepted PY - 2020/6/20/pubmed PY - 2020/6/20/medline PY - 2020/6/20/entrez KW - Appendicitis KW - Opioid stewardship KW - Opioid-induced hyperalgesia KW - Postoperative analgesia KW - Preoperative opioids SP - 144 EP - 151 JF - The Journal of surgical research JO - J. Surg. Res. VL - 255 N2 - BACKGROUND: In light of current opioid-minimization efforts, we aimed to identify factors that predict postoperative opioid requirement in pediatric appendicitis patients. METHODS: A single-center retrospective cohort study was conducted of children (<18 y) who underwent laparoscopic appendectomy for acute appendicitis between January 1, 2018 and April 30, 2019. Patients who underwent open or interval appendectomies were excluded. The primary outcome was morphine milliequivalents (MMEs) per kilogram administered between 2 and 24 h after surgery. Multivariable analyses were performed to evaluate predictors of postoperative opioid use. Clinically sound covariates were chosen a priori: age, weight, simple versus complicated appendicitis, preoperative opioid administration, and receipt of regional or local anesthesia. RESULTS: Of 546 patients, 153 (28%) received postoperative opioids. Patients who received postoperative opioids had a longer median preadmission symptom duration (48 versus 24 h, P < 0.001) and were more likely to have complicated appendicitis (55% versus 21%, P < 0.001). Patients who received postoperative opioids were more likely to have received preoperative opioids (54% versus 31%, P < 0.001). Regional and local anesthesia use was similar between groups. Nearly all patients (99%) received intraoperative opioids. Each preoperative MME per kilogram that a patient received was associated with receipt of 0.29 additional MMEs per kilogram postoperatively (95% confidence interval, 0.19-0.40). CONCLUSIONS: Preoperative opioid administration was independently associated with increased postoperative opioid use in pediatric appendicitis. These findings suggest that preoperative opioids may potentiate increased postoperative pain. Limiting preoperative opioid exposure, through strategies such as multimodal analgesia, may be an important facet of efforts to reduce postoperative opioid use. SN - 1095-8673 UR - https://www.unboundmedicine.com/medline/citation/32559522/Preoperative_Opioids_Associated_With_Increased_Postoperative_Opioid_Use_in_Pediatric_Appendicitis L2 - https://linkinghub.elsevier.com/retrieve/pii/S0022-4804(20)30295-X DB - PRIME DP - Unbound Medicine ER -
Try the Free App:
Prime PubMed app for iOS iPhone iPad
Prime PubMed app for Android
Prime PubMed is provided
free to individuals by:
Unbound Medicine.