Parental Report of Morphine Use at Home after Pediatric Surgery

Abou-Karam, Myrna; Dubé, Sandrine; Kvann, H Soriya; Mollica, Corina; Racine, Dariane; Bussières, Jean-François; Lebel, Denis; Nguyen, Christina; Thibault, Maxime

doi:10.1016/j.jpeds.2015.06.035

Cited by 31 publications

(20 citation statements)

References 21 publications

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“…However, we also found that opioid over-dispensing was common in keeping with prior adult and pediatric studies. 24,25 For example, Abou-Karam and colleagues previously reported that most children consumed no more than 2 doses of morphine (< 10% of doses dispensed) following hospital discharge. 25 We are not surprised that our patients required more opioid doses upon discharge than they report, as we hypothesize that they often underwent more complex or painful procedures based on hospital length of stay and surgical service.…”

Section: Discussionmentioning

confidence: 99%

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

Monitto

Hsu

Gao

et al. 2017

Anesthesia &Amp; Analgesia

121

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Introduction The epidemic of nonmedical use of prescription opioids (NMUPO) has been fueled by the availability of legitimately prescribed unconsumed opioids. The aim of this study was to better understand the contribution of prescriptions written for pediatric patients to this problem by quantifying how much opioid is dispensed and consumed to manage pain following hospital discharge, and whether leftover opioid is appropriately disposed of. Our secondary aim was to explore the association of patient factors with opioid dispensing, consumption and medication remaining upon completion of therapy. Methods Using a scripted 10-minute interview, parents of 343 pediatric inpatients (98% post-operative) treated at a university children’s hospital were questioned within 48 hours and 10–14 days after discharge to determine amount of opioid prescribed and consumed, duration of treatment, and disposition of unconsumed opioid. Multivariable linear regression was used to examine predictors of opioid prescribing, consumption, and doses remaining. Results Median number of opioid doses dispensed was 43 (IQR, 30–85 doses), and median duration of therapy was 4 days (IQR, 1–8 days). Children who underwent orthopedic or Nuss surgery consumed 25.42 [95% CI, 19.16–31.68] more doses than those who underwent other types of surgery (p < 0.001), and number of doses consumed was positively associated with higher discharge pain scores (p = 0.032). Overall 58% [95% CI, 54%–63%] of doses dispensed were not consumed, and the strongest predictor of number of doses remaining was doses dispensed (p < 0.001). Nineteen percent of families were informed how to dispose of leftover opioid, but only 4% (8/211) did so. Discussion Pediatric providers frequently prescribed more opioid than needed to treat pain. This unconsumed opioid may contribute to the epidemic of NMUPO. Our findings underscore the need for further research to develop evidence-based opioid prescribing guidelines for physicians treating acute pain in children.

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Section: Discussionmentioning

confidence: 99%

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

Monitto

Hsu

Gao

et al. 2017

Anesthesia &Amp; Analgesia

121

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“…22,33,46 Among pediatric patients with obstructive sleep apnea who underwent tonsillectomy, Kelly and colleagues 48 described a significantly higher frequency of oxygen desaturation with oral morphine. We chose not to measure this outcome because our sample included children with orthopedic pathology and excluded patients with obstructive sleep apnea.…”

Section: Discussionmentioning

confidence: 99%

“…Concerns about adverse effects are prevalent (73%) among caregivers of children who undergo outpatient surgery, 3 as are concerns regarding the addictive potential of opioids. 3,33 These concerns may be fueled by recent pediatric evidence of long-term risks 53 and increased hospital admissions related to opioids.…”

Section: Discussionmentioning

confidence: 99%

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Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial

Poonai

Datoo

Ali

et al. 2017

CMAJ

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“…35 Similar results were found with oral surgery 36 and pediatric surgery. 37 A study including thoracic and gynecologic surgery patients showed that 83 percent had leftover opioid medication and 71 to 73 percent stored the leftovers unsafely. 38 This unsafe handling of opioids is not unique to surgical patients—a large proportion of oncology patients 39 and those receiving opioids in the emergency room 40 did not dispose of or store their medications properly.…”

Section: Opioid Risk and Surgerymentioning

confidence: 99%

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

Demsey

Carr

Clarke

et al. 2017

Plastic &Amp; Reconstructive Surgery

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Summary Opioid addiction is a public health crisis that affects all areas of medicine. Large numbers of the population across all racial and economic demographics misuse prescription opioids and use illicit opioids. The current understanding is that opioid misuse is a disease that requires treatment, and is not an issue of choice or character. Use of opioid medication is a necessary part of postoperative analgesia, but many physicians are unsure of how to do this safely given the risk of patients developing an opioid misuse disorder. This review gives an update of the current state of the opioid crisis, explains how current surgeons prescribing practices are contributing to it, and gives recommendations on how to use opioid medication safely in the perioperative period.

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Parental Report of Morphine Use at Home after Pediatric Surgery

Cited by 31 publications

References 21 publications

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

Opioid Prescribing for the Treatment of Acute Pain in Children on Hospital Discharge

Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial

Managing Opioid Addiction Risk in Plastic Surgery during the Perioperative Period

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