Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis

Abstract

Background: Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid administration, and test the associations between opioid administration and hospital length of stay (LOS). Methods: This is a retrospective cohort study of pediatric AP hospitalizations in a single institution from 2010 to 2020. Opioid administration was calculated for the first 48 hours of admission (morphine milligram equivalent; MME48). Data on multimodal analgesia [defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs)] during hospitalization was captured. Results: The sample included 224 patients, mean age 12.0 years (standard deviation = 4.9) and 58.9% female. Median LOS was 4 days (interquartile range 2-9). Most patients (71.4%) were prescribed opioids, 77.7% acetaminophen, 40.2% NSAIDs, and 37.5% multimodal analgesia. Opioid administration decreased over the study period; in contrast, there was an increase in multimodal analgesia administration. Opioid administration did not differ by sex, age, biliary versus non-biliary etiology, or race/ethnicity. In a multivariate regression model, lower albumin values (P < 0.01) and younger age (P < 0.05) were significant predictors of increased LOS, while MME48 was not associated with increased LOS. Conclusions: Opioids were commonly administered; only 37.5% of children were administered multimodal analgesia during their hospitalization for AP. Opioid administration was not associated with increased LOS. Prospective studies are needed to determine optimal pain management for pediatric AP.

Acute pancreatitis in children: risk factors, management, and outcomes

“…Studies evaluating effective pain management regimens are scarce and there is no current consensus approach. Many patients will require opioids to manage pain [4,33,34 ▪ ], but where possible, opioid-sparing regimens utilizing acetaminophen and NSAIDs such as ketorolac are preferred [35]. Pain specialists should be consulted when patients are experiencing more severe or prolonged pain [10].…”