Trends in perioperative opioid and non-opioid utilization during ambulatory surgery in children

Rizeq, Yazan; Many, Benjamin T.; Vacek, Jonathan; Silver, Isaac M.; Goldstein, Seth D.; Raval, Mehul V.

doi:10.1016/j.surg.2019.04.005

Cited by 19 publications

(18 citation statements)

References 23 publications

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“…The timing of this downtrend is consistent with trends reported nationally and coincides with the release of the updated CDC guidelines for opioid prescribing that encourage a general reduction in opioid use across most clinical situations. (7,9,18) To our knowledge, this is the first study examining county-level opioid dispensing in California within the time period of this study. Although studies examining national trends generally agree that the use of opioids in pediatric patients has overall decreased in recent years, there is uncertainty with how specific regions contribute to the trend -one study reported the western states with having the lowest prescribing rates (19) , while another found the West to have the highest.…”

Section: Discussionmentioning

confidence: 98%

Evaluating Opioid Dispensing Rates among Pediatrics and Young Adults based on CURES Data Reporting in California from 2015-2019

Phan

Wong

Tomaszewski

et al. 2021

J Contemp Pharm Pract

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Background Receipt of opioid prescriptions in pediatric and young adult patients may be a risk factor for future opioid misuse. Data from prescription drug monitoring programs provide insight on outpatient opioid use. In our study, we analyzed the opioid dispensing rates for pediatrics and young adults in California. Methods A secondary analysis was performed from 2015-2019 using Controlled Utilization Review and Evaluation System data. This database provides dispensing data of controlled substances in California. Patients younger than 25 years who were prescribed opiates were analyzed by county. We further divided them into two groups (children: ≤14 years; adolescents and young adult: 15-24 years). Descriptive statistics and heat maps were used to illustrate the trends in opioid usage among different age groups. Results The overall percentages for the number of opioids being dispensed to patients aged <25 years have decreased over the past four years. In 2015, 6 out of 58 counties in California were considered “high-rate” with >2.9% of opioids dispensed to patients younger than 25 years old; in 2019, this number reduced to zero. Patients 25 and older received a higher proportion of opioids compared to younger populations; in 2019, 35.91% of opioids were dispensed to patients 45-64, and 8.92% to patients younger than 25. Conclusion Pediatric opioid prescriptions have declined over the recent years. However, a high degree of variability of prescription rates between demographic counties was noted. More studies are warranted in order to understand this discrepancy in opioid prescribing among pediatric and young adult patients.

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Section: Discussionmentioning

confidence: 98%

Evaluating Opioid Dispensing Rates among Pediatrics and Young Adults based on CURES Data Reporting in California from 2015-2019

Phan

Wong

Tomaszewski

et al. 2021

J Contemp Pharm Pract

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“…Aside from pointing to the low overall pain levels associated with both groups, these findings likely reflect the national shift to nonopioid analgesic medication use, identified in ambulatory pediatric surgery as well. 31…”

Section: Discussionmentioning

confidence: 99%

Assessment of Pain and Analgesic Use in Children Following Otologic Surgery

Benchetrit

Kwock

Ronner

et al. 2020

Otolaryngol.--head neck surg.

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Objective To compare postoperative pain and analgesic use in children following transcanal endoscopic ear surgery (TEES) vs non–transcanal endoscopic ear surgery (non-TEES). Study Design Prospective case series. Setting Tertiary care center. Methods Surveys using the Wong-Baker FACES Pain Rating Scale and recording the frequency and dosage of consumed analgesics were administered prospectively to caregivers of children undergoing otologic surgery between May 2018 to February 2020. Pain intensity and medication use were recorded twice daily for 6 days, starting on postoperative day 0. Mean pain scores and mean number of consumed analgesic doses were compared between groups. Results Survey response rate was 57.9%. Among 53 patients who completed the survey, 35 (66.0%) underwent TEES and 18 (34.0%) underwent non-TEES. Mean pain ratings on postoperative days 0 and 1 were significantly lower among children undergoing TEES (2.2 and 2.1) vs non-TEES (4.0 and 4.1), P = .045 and P = .008, respectively (Mann-Whitney U test). The mean pain ratings across the 6 days were similar in TEES (1.7) and non-TEES (2.6) ( P = .140, Mann-Whitney U test). The mean number of analgesic doses consumed per half-day over the 6 days was significantly lower among children undergoing TEES (0.3) vs non-TEES (0.6; P = .049, Mann-Whitney U test). Conclusion Postoperative pain following TEES and non-TEES in children was overall low. Children undergoing TEES had a small but statistically significant decrease in pain on postoperative days 0 and 1 and decreased use of pain medications compared to non-TEES.

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“…Dado la incidencia de dolor severo descrita, algunos pacientes requieren opioides. Su perfil de EA como náuseas, vómitos o depresión respiratoria limitan su uso, especialmente en contexto ambulatorio dado que prolongan la estadía en recuperación y aumentan las consultas y hospitalizaciones no programadas [2], [7]. En USA se ha visto que un 4,8% de los niños (> 13 años) tienen un consumo persistente de opioides posterior a la cirugía, con riesgo de generar dependencia [8].…”

Section: Dolor Posoperatorio En Cirugía Ambulatoria Pediátricaunclassified

“…La rápida recuperación de los pacientes pediátricos y la ausencia de comorbilidades hacen factible el alta precoz en cirugías de baja-mediana complejidad, reduciendo la ansiedad de separación y los costos asociados a hospitalización [1]. El manejo adecuado del dolor posoperatorio es relevante, buscando una cobertura permanente para evitar las tasas de dolor moderado-severo, descritas en 30%-70% [2], [3], el cual puede prolongarse varios días [4]. Esto se ha asociado a mayores costos y consecuencias adversas físicas y psicológicas [1].…”

Section: Introductionunclassified

“…El manejo del dolor posoperatorio se realiza dentro de esquemas de analgesia multimodal, incluyendo el uso de anestésicos locales (AL), analgésicos orales como paracetamol, antiinflamatorios no esteroidales (AINES) u opioides. Estos últimos, si bien proporcionan buena analgesia, dado su perfil de efectos adversos (EA) son cada vez menos usados en contexto ambulatorio [2]. La anestesia regional constituye un pilar fundamental, siendo los bloqueos caudales (BC) los más utilizados para proporcionar analgesia intra y posoperatoria.…”

Section: Introductionunclassified

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