The impact of intravenous opioid shortages on postoperative pain control in a pediatric cardiac intensive care unit

Abstract

Background The national supply of intravenous pain medications has been restricted since 2018 due to shortages. In late 2017, the ongoing shortages combined with the increased demand for alternative formulations resulted in interruptions in the supply of medications. The cascading effect of interruptions in supply caused hospitals to implement restrictive measures to extend the availability of these medications. This study aims to evaluate differences in pain control in postoperative cardiac patients due to intravenous opioid shortage at a standalone pediatric hospital. Method A retrospective chart review of postoperative patients in the cardiac intensive care unit at Children's National Hospital was conducted from January to September 2017 and 2018. The objective of this study is to determine if a difference in postoperative pain scores in the period before and during the national intravenous opioid shortage exists, analyzed by differences in Face, Legs, Activity, Cry, Consolability (FLACC) scores. Results No differences were found in mean FLACC scores for the 140 patients who were evaluated. Patients in 2017 reported faster decline of pain symptoms compared with those in 2018. No differences in baseline characteristics or secondary outcomes were noted. Conclusion Pain management was better controlled immediately postoperatively in 2018 compared with 2017, but the pain was better controlled for the duration of the postoperative period in 2017.

A Novel Use of Liposomal Bupivacaine in Erector Spinae Plane Block for Pediatric Congenital Cardiac Surgery

“…A more recent study reported the opioid requirements of postoperative pediatric cardiac surgical patients for two consecutive years. e average IV morphine equivalents on POD1 were 2.2/2.17 mg/kg/day (2017/2018), and the average for the first five postoperative days was 0.86/0.62 mg/kg/day (2017/ 2018) [14].…”

Managing drug shortages in pediatric care

“…According to Barnes et al, 2020, fentanyl and hydromorphone were the primary intravenous opioids utilized in response to the limited availability of morphine during the 2018 shortages. An increased use of adjuvant pain medications, including acetaminophen and nonsteroidal antiinflammatory drugs was also seen, but not significantly (Barnes et al, 2020).…”

“…In the study by Barnes et al, 2020, the Children's National Medical Center implemented an opioid stewardship program to address opioid shortages in late 2017. To achieve this, a task force was created to integrate opioid intravenous to per os conversion alerts into daily workflow, educate providers, and send weekly shortage emails.…”

“…In a study conducted by Barnes et al, 2020, the institution being researched implemented provider education as a strategy during an opioid shortage. This approach is believed to have prevented higher rates of uncontrolled pain or increased adverse events, when coupled with appropriate pharmacy education (Barnes et al, 2020).…”

<p>The United States Drug Enforcement Administration and Prescription Opioid Production Quotas: An End Game of Eradication?</p>

“…11 Other subsequent commentaries and studies have confirmed the challenges associated with treating inpatients' pain due to the APQ reductions, [12][13][14][15][16][17][18] including those addressing treating children perioperatively and postoperatively. 19,20 Up to this point, reports of APQ reduction-related shortages of oral opioids are only anecdotal, with numerous reports from patients on social media. In these cases, the patients (generally suffering from chronic non-cancer pain) report that their pharmacies have "run out" of medications that they have taken for many years, although these patients have not been privy to whether these lacks of availability are due to APQ reductions or other supplyside issues within their own pharmacies.…”