Race and Unequal Burden of Perioperative Pain and Opioid Related Adverse Effects in Children

Abstract

BACKGROUND: Interindividual variability in pain perception and analgesic response is a major problem in perioperative practice. Adult studies suggest pain management is influenced by patient’s race. The objective of this study is to evaluate the influence of race on perioperative pain treatment in children. METHODS: Prospective observational study evaluating effect of race on analgesia and opioid related adverse effects after tonsillectomy in African American and Caucasian children. A sample of 194 healthy children between 6 and 15 years of age were included. Race was self-identified by parents. All participants received standard perioperative care with a standard anesthetic and an intraoperative dose of morphine. Analgesia outcomes included maximum postoperative pain scores, postoperative opioid requirement, and analgesic interventions. Safety outcomes included incidences of opioid related adverse effects. RESULTS: African American children experienced significantly more postoperative pain than Caucasian children as measured by postoperative opioid requirement (P = .0011), maximum postoperative pain scores (P < .0001), and analgesic interventions (P < .0001) in the recovery room. Although Caucasian children received relatively less opioids perioperatively, they had significantly higher opioid related adverse effects (P = .039). African American children with obstructive sleep apnea were more likely to have prolonged post anesthesia recovery unit stay due to inadequate pain control. CONCLUSIONS: After similar uses of intraoperative morphine for tonsillectomy, there was an unequal burden of increased pain in African American children and increased opioid adverse effects in Caucasian children in the recovery room. Though Caucasian children received relatively less opioids perioperatively, they had higher incidences of opioid related adverse effects than African American children.

Challenges and cautions with small and retrospective postoperative pain genome-wide association studies with TAOK3

“…In addition to methodological concerns, it should be noted that the findings of this study contradicted previously reported associations of morphine consumption with race [4,5] and sex [3]. Specifically, Cook-Sather et al found that children from EC ancestry had a significantly higher morphine requirement than children of AA ancestry, a finding that contradicts previous reports in a similar pediatric surgical population [4,5] and a systematic meta-analysis of studies that showed that sex differences exist in morphine-induced analgesia in both experimental pain studies and clinical studies, with greater morphine efficacy in female patients.…”

Racial and Ethnic Disparities in Adverse Drug Events: A Systematic Review of the Literature

“…Chart review was used as a primary ADE detection method in 35 % (14/40) of studies [8,[24][25][26][27][28][29][30][31][32][33][34][35][36], and survey or patient/ parent report was used in 27.5 % (11/40) of the studies [27,32,33,[37][38][39][40][41][42][43][44]. Direct documentation by research staff was used by three studies (7.5 %) [45][46][47]. Three studies (7.5 %) used more than one method for ADE detection [27,32,33]; two of these studies that analyzed agreement between methods of ADE detection found that only 5-6 % of ADEs were detected by both chart review and patient report [27,33].…”

Addressing the Differences by Race in Analgesia Use among Pediatric Patients Attending Emergency Departments

“…Recent evaluations have suggested that total body weight (TBW) and LBM are the preferred size descriptors for maintenance medication dosing in obese patients. 4,5 The calculation of LBM, however, involves complex equations based on age, sex, height, proportionality constant, and/or z-score attained from a secondary source. This calculation poses a serious logistic challenge in emergency situations when accurate measurement of these parameters may be very difficult.…”

“…4 The racial disparities in pain management is troubling as African American pediatric patients experience more postoperative pain than their White counterparts and yet are prescribed opioids at lower rates. 5 There appear to be various reasons why these disparities persist.…”