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Predicting and Managing Pediatric Postoperative Pain in the Age of Opioid Abuse

Bernstein, Jaime L. MD; Schlechtweg, Kathryn Anna BS; Fullerton, Natalia MD; Imahiyerobo, Thomas MD

Plastic and Reconstructive Surgery - Global Open: August 2019 - Volume 7 - Issue 8S-1 - p 52-53
doi: 10.1097/01.GOX.0000584500.75100.e1
Craniofacial Abstracts

New York Presbyterian Hospital of Cornell and Columbia, New York, NY

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

PURPOSE: Opioid abuse and overdose have become an epidemic in the United States, and overprescribing by physicians has been shown to be a major contributor to this morbidity and mortality. The opioid epidemic is especially problematic in the pediatric population, as early exposure has been linked to potential future illicit drug use. Currently, it is common to prescribe pediatric patients opioids for postoperative pain control, although there is a lack of evidence for their necessity in pediatric ambulatory surgery. This study aims to investigate postoperative pain management in the ambulatory pediatric plastic surgery setting and the role of prescribed narcotics to guide future pain management of this vulnerable population.

METHODS AND MATERIALS: This is an observational, prospective study of patient pain management practices and their effectiveness. A questionnaire was developed to interrogate postoperative pain, narcotic use, and pain management practices. All assenting patients and parents of pediatric plastic surgery patients, ages 0–17, who underwent an ambulatory procedure by one attending surgeon from March 2018 to February 2019, were asked to participate in the study. The questionnaire was given at the first postoperative clinic visit. Supplemental clinical data were obtained from patient charts. T test and univariate analysis were performed to identify significant contributing factors of narcotic use.

RESULTS: Fifty-three patients participated in the study, 34% (18) males and 66% (35) females. Age ranged from 1 to 17, with an average of 8 years old. All patients were offered a prescription for narcotic pain medication, most commonly oxycodone, with 85% (45) filling the prescription, 38% (20) taking ≥1 dose of narcotics, and only 11% (6) taking ≥4 doses. Univariate analysis found no significant difference in the amount of narcotic used based on gender or age (odds ratio [OR], 1.03; P = 0.575; and OR, 0.904; P = 0.086, respectively). However, patient use of narcotic pain medication could be predicted based on type of procedure, comparing simple soft tissue lesion excision to all other procedures, such as otoplasty and rhinoplasty (OR, 0.207; confidence interval, 0.052–0.819; P = 0.025). Patients on average found the efficacy of the narcotics to be comparable to that of over the counter analgesics (4.2/5 and 4.5/5; P = 0.387). Of the patients who filled the narcotic prescription, not one patient properly disposed of it postoperatively, with nearly 50% (18) keeping the extra in their home.

CONCLUSION: This study demonstrates that most ambulatory plastic surgery pediatric patients will have sufficient pain relief with only over the counter pain medications, without the need for narcotic prescriptions. This study also demonstrates that the type of surgery can be used as a guideline for who should receive a narcotic prescription postoperatively. Additionally, education on proper disposal of narcotic medications may be a simple and effective target to decrease opioid availability for abuse. In an era of opioid abuse and misuse, which has been propagated by clinician’s opioid prescription practices, this research deepens the physicians’ understanding of postoperative pain management in pediatric plastic surgery ambulatory patients and serves to guide future pain management and narcotic regimens.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons. All rights reserved.