Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Kelley-Quon, Lorraine I.; Kirkpatrick, Matthew G.; Ricca, Robert L.; Baird, Robert; Harbaugh, Calista M.; Brady, Ashley E.; Garrett, Paula; Wills, Hale; Argo, Jonathan; Diefenbach, Karen A.; Henry, Marion C.W.; Sola, Juan E.; Mahdi, Elaa; Goldin, Adam B.; Peter, Shawn D. St.; Downard, Cynthia D.; Azarow, Kenneth S.; Shields, Tracy; Kim, Eugene

doi:10.1001/jamasurg.2020.5045

Cited by 114 publications

(123 citation statements)

References 287 publications

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“…Since implementation at 43 hospitals, there has been a significant reduction in the quantity of opioids prescribed after surgery and a corresponding reduction in opioid consumption by patients [474]. Subsequently, multiple other collaboratives have also published postoperative opioid prescribing guidelines for adults [30,31,475,476] and for children [477].…”

Section: Discharge Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a “roadmap” for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.

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Section: Discharge Phasementioning

confidence: 99%

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

et al. 2021

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“…39 Avoiding opioid prescribing for surgical and dental procedures not only decreases the risk of misuse and overdose but also decreases the risk of side effects, such as vomiting and constipation. 40 Consequently, when nonopioids provide effective analgesia, first-line use of these medications could improve safety and patient experience.…”

Section: Figurementioning

confidence: 99%

Opioid Prescribing to US Children and Young Adults in 2019

et al. 2021

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BACKGROUND: Recent national data are lacking on the prevalence, safety, and prescribers of opioid prescriptions dispensed to children and young adults aged 0 to 21 years. METHODS:We identified opioid prescriptions dispensed to children and young adults in 2019 in the IQVIA Longitudinal Prescription Database, which captures 92% of US pharmacies. We calculated the proportion of all US children and young adults with $1 dispensed opioid prescription in 2019. We calculated performance on 6 metrics of high-risk prescribing and the proportion of prescriptions written by each specialty. Of all prescriptions and those classified as high risk by $1 metric, we calculated the proportion written by high-volume prescribers with prescription counts at the $95th percentile.RESULTS: Analyses included 4 027 701 prescriptions. In 2019, 3.5% of US children and young adults had $1 dispensed opioid prescription. Of prescriptions for opioid-naive patients, 41.8% and 3.8% exceeded a 3-day and 7-day supply, respectively. Of prescriptions for young children, 8.4% and 7.7% were for codeine and tramadol. Of prescriptions for adolescents and young adults, 11.5% had daily dosages of $50 morphine milligram equivalents; 4.6% had benzodiazepine overlap. Overall, 45.6% of prescriptions were high risk by $1 metric. Dentists and surgeons wrote 61.4% of prescriptions. High-volume prescribers wrote 53.3% of prescriptions and 53.1% of high-risk prescriptions.CONCLUSIONS: Almost half of pediatric opioid prescriptions are high risk. To reduce high-risk prescribing, initiatives targeting high-volume prescribers may be warranted. However, broadbased initiatives are also needed to address the large share of high-risk prescribing attributable to other prescribers.

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“…Despite the inherent risks, the use of prescription opioids remains an important strategy to manage severe, acute postoperative pain in children and adolescents. 1,2 However, the ongoing opioid crisis may have impacted public sentiment regarding opioid analgesics in ways that affect pediatric pain management. Increasing and alarming rates of prescription opioid-related adverse events, misuse, deaths, and opioid use disorder have elicited widespread attention from healthcare providers, policymakers, and the media.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the inherent risks, the use of prescription opioids remains an important strategy to manage severe, acute postoperative pain in children and adolescents 1,2 . However, the ongoing opioid crisis may have impacted public sentiment regarding opioid analgesics in ways that affect pediatric pain management.…”

Section: Introductionmentioning

confidence: 99%

To relieve pain or avoid opioid‐related risk? A comparison of parents’ analgesic trade‐off preferences and decision‐making in 2019 versus 2013 in a single U.S. pediatric hospital

Lenko

Voepel‐Lewis

2021

Pediatric Anesthesia

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Background: Analgesic trade-off preferences, or the relative preference for pain relief vs. risk aversion, shape parents' decisions to give prescription opioids to their children.These preferences may be influenced by personal experiences and societal factors.Aim: To examine whether parental analgesic trade-off preferences and opioid decisionmaking have shifted toward risk aversion during the opioid crisis in the United States. Methods:We conducted a secondary analysis of the preoperative survey data of parents from a single U.S. pediatric hospital whose children aged 5-17 years were to undergo painful surgery in 2013 (Time 1) or 2017/2019 (Time 2). Surveys assessed parents' analgesic trade-off preference (−12 or risk-averse to +12 or pain relief preferent, scores around 0=ambivalent) and their hypothetical decisions to give a prescribed opioid to a child in pain.Results: Data from 847 parents were included (Time 1, n = 361; Time 2, n = 486).Parents at Time 2 were significantly more risk-averse compared with Time 1 (adj.β: −0.84 [95% CI: −1.09, −0.60]). Parents at Time 2 were more than twice as likely to be risk-averse or ambivalent (OR: 2.17 [95% CI: 1.62, 2.91]). There was a significant interaction effect of Time*Preference on parents' decision to give the opioid (adj. OR:1.09 [95% CI: 1.03, 1.16]). At Time 2, parents who were ambivalent or risk-averse were less likely than those who preferred to relieve pain to administer the prescribed opioid (OR: 0.57 [95% CI: 0.37, 0.89]). In contrast, there was no association between the preference group and the opioid decision at Time 1. Conclusion:Findings suggest that parents of children scheduled for painful surgery at our pediatric hospital have become more analgesic risk-averse during the past decade.Parents' analgesic trade-off preferences may influence their decisions to administer prescribed opioids after surgery, which may contribute to children's pain outcomes. K E Y W O R D Schildren, decision-making, opioid analgesics, opioid epidemic, pain management, parents What is already knownParents' decisions to administer prescribed opioids to children are influenced, in part, by their risk perceptions and analgesic preferences. | 879 LENKO aNd VOEPEL-LEWIS What new information this study addsParents' analgesic preferences have shifted toward risk aversion during the opioid crisis, which may influence them to withhold prescription opioids for a child in pain.How to cite this article: Lenko R, Voepel-Lewis T. To relieve pain or avoid opioid-related risk? A comparison of parents' analgesic trade-off preferences and decision-making in 2019 versus 2013 in a single U.S. pediatric hospital.

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Guidelines for Opioid Prescribing in Children and Adolescents After Surgery

Cited by 114 publications

References 287 publications

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Opioid Prescribing to US Children and Young Adults in 2019

To relieve pain or avoid opioid‐related risk? A comparison of parents’ analgesic trade‐off preferences and decision‐making in 2019 versus 2013 in a single U.S. pediatric hospital

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