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Tolerance of Oral Opioid Medication After Surgery for Ruptured Appendicitis in Pediatric Patients: A Pilot Study

Wilson-Kocovsky, Kathleen, RN, BSN; Sudar, Kimberly, RN, BSN, CPN

Journal of Pediatric Surgical Nursing: July/September 2018 - Volume 7 - Issue 3 - p 88–92
doi: 10.1097/JPS.0000000000000174
Feature Article

Introduction: Each year, numerous children undergo surgery and require oral opioids during their postoperative recovery. Little is known about when children who have been on a nothing-by-mouth diet after surgery can tolerate oral opioids. Although oral opioids offer advantages over the intravenous route, healthcare professionals have differing opinions regarding how much oral intake (liquids or solids) a patient needs to tolerate before starting oral opioids. This could lead to inconsistencies in practice, which could impact patients' comfort, length of stay, and, ultimately, healthcare costs. The primary purpose of this study was to identify current practice regarding initiation of oral opioids in pediatric patients recovering from an appendectomy for ruptured appendicitis. On the basis of this data, our team aimed to provide a best practice recommendation for this population.

Methods: A retrospective chart review was conducted from a sample of 43 children recovering from an appendectomy secondary to ruptured appendicitis. Data included time from surgery to ingestion of clear liquids, administration of oral opioids, and occurrence of emesis in relation to either of these administrations.

Results: Children received from 30 ml to an average of 354 ml of clear liquids before taking oral opioids, and no patients had emesis documented regardless of the volume of clear liquids they ingested before administration of oral opioids.

Discussion: Results suggest that pediatric patients may be able to tolerate oral opioids regardless of the amount of clear liquids they tolerate beforehand. Although more studies are needed to support these results, such results could mean earlier transition from intravenous to oral opioids, which could decrease healthcare costs and potentially decrease length of stay.

Kathleen Wilson-Kocovsky, RN, BSN Pediatric Staff Nurse, Level 2, Children's Hospital of Wisconsin, Milwaukee, WI.

Kimberly Sudar RN, BSN, CPN Pediatric Staff Nurse, Level 2, Children's Hospital of Wisconsin, Milwaukee, WI.

The authors have declared no conflict of interest.

Correspondence: Kathleen Wilson-Kocovsky, RN, BSN, Children's Hospital of Wisconsin, P.O. Box 1997, MS 260, Milwaukee, WI 53226. E-mail:

Copyright © 2018 American Pediatric Surgical Nursing Association
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