Variations in Perceptions of Postoperative Opioid Need for Pediatric Surgical Patients

Stokes, Sarah C.; Theodorou, Christina M.; Brown, Erin G.; Saadai, Payam

doi:10.1001/jamasurg.2021.2076

“…6 Correspondingly, a recent survey showed an increase in the anticipated opioid demand with rising age of the pediatric patient. 32 As elevated body temperature is associated with inflammation, we expected fever to correlate with opioid requirements. 33 Interestingly, this was not the case.…”

Section: Discussionmentioning

confidence: 99%

A Novel Tool to Predict Postoperative Opioid Need after Laparoscopic Appendectomy in Children: A Step toward Evidence-Based Pain Management

Unglert

¹

,

Lehnick

²

,

Szavay

³

et al. 2022

Eur J Pediatr Surg

0

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Background Optimizing postoperative pain treatment is essential to minimize morbidity, lower costs, and ensure patient and parent satisfaction. This study aims at identifying pre- and intraoperative parameters predicting opioid needs after laparoscopic appendectomy to enable timely and adequate postoperative pain control. Materials and Methods A retrospective analysis of patients treated with laparoscopic appendectomy for appendicitis between January 2018 and March 2019 was performed. Multiple logistic regression was applied to identify predictors of opioid demand. Results Based on our analysis, we developed a prediction tool for opioid requirements after laparoscopic appendectomies in children. The integrated parameters are: presence of turbid fluid, age, white-blood-cell count, symptom duration, and body temperature. Conclusion We developed an algorithm-based predictor tool that has the potential to better anticipate postoperative pain and, thereby, optimize pain management following laparoscopic appendectomies in children. The proposed predictor tool will need validation through further prospective studies.

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“…As Ilhan and Hush detail, we found that most pediatric surgeons and surgical residents did not discuss alternative pain management strategies with patients and their families. 3 In developing opioid-free perioperative pain management protocols for children, incorporation of family education is critical. Comprehensive caregiver education with inclusion of nonpharmacologic interventions can improve postoperative pain management.…”

Section: Emre Ilhan Phd Julia M Hush Phdmentioning

confidence: 99%

“…To the Editor We read with interest the Research Letter by Stokes et al, who administered a survey to evaluate the perceived need for postoperative opioids in children between age 1 and 17 years by pediatric surgeons, postanesthesia care unit nurses, and surgical residents. The authors reported that pediatric surgeons believed all children, regardless of age, required 0 days of opioid therapy following surgery.…”

mentioning

confidence: 99%

Surgeon Perception That Opioids Are Not Needed for Young Children Postoperatively

İlhan

¹

,

Hush

²

2022

JAMA Surg

0

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plant program adds another recipient, not selected by the donor, who lacks a donor.Besides such standard voucher cases, conversations with prospective altruistic donors revealed an additional use for vouchers; some people wanted to help others by providing a kidney but held back from doing so because they worried that a relative might need a transplant in the future and they would be unable to help, having already given a kidney as a nondirected donor. By providing them with a family voucher, one of a group of up to 5 people designated by the donor who are not then awaiting a transplant could later receive a kidney should that become necessary.Matas's separation of the 3 overlapping categories of kidney donation allows him to claim that vouchers uniquely raise ethical concerns. Yet, one ought to be more concerned about the factual as well as the ethical basis for a system of financial incentives to kidney donors that Matas recommended recently, when the ground for his proposal is that the attempts made in the past 2 decades "to increase the number of both living donors . . . and deceased donors" have produced "little change in the number of donated kidneys." 4 In fact, between 2000 and 2020, the number of deceased donor kidney transplants more than doubled (from 8126 to 17 583), which is hardly "little change." Anyone who wants to see an increase in kidney transplants from living donors, which rose from 5505 in 2000 to a record 7397 in 2019 before the COVID-19 pandemic reduced donations in 2020, should support an expansion of the voucher system rather a trial of paying donors. The ethical concerns raised by paying financial incentives, a radical departure from the norms that have guided organ donation for more than half a century, far exceed any implicated by voucher programs.

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“…These authors did note that high-quality evidence for opioid-free recovery for most surgical procedures is still emerging (Table 4 3 ). Although the concern about the addictive nature of opioids is a worthy one, 3 and evidence for nonopioid postoperative pain relief is limited, a balanced argument supporting compassionate care to all children who undergo surgery would have been helpful in the Research Letter by Stokes et al 1 Specifically, it would have been of value for the investigators to consider in their discussion the underlying factors that drive surgeons' perceptions on pediatric pain management in the context of greater clinical and ethical implications.…”

Section: Surgeon Perception That Opioids Are Not Needed For Young Chi...mentioning

confidence: 99%

“…4 However, surgeons and residents typically do not devote significant time to this discussion. 3,5 Evaluation of pain and patient education is routinely incorporated into nursing education but is less emphasized in surgical residency training. 6 The results of our study illustrate the need for a standardized preoperative pain management discussion and educational pain management videos for families, and we have incorporated these interventions into our opioid reduction efforts.…”

Section: Emre Ilhan Phd Julia M Hush Phdmentioning

confidence: 99%

Surgeon Perception That Opioids Are Not Needed for Young Children Postoperatively—Reply

Stokes

¹

,

Saadai

²

2022

JAMA Surg

Self Cite

0

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plant program adds another recipient, not selected by the donor, who lacks a donor.Besides such standard voucher cases, conversations with prospective altruistic donors revealed an additional use for vouchers; some people wanted to help others by providing a kidney but held back from doing so because they worried that a relative might need a transplant in the future and they would be unable to help, having already given a kidney as a nondirected donor. By providing them with a family voucher, one of a group of up to 5 people designated by the donor who are not then awaiting a transplant could later receive a kidney should that become necessary.Matas's separation of the 3 overlapping categories of kidney donation allows him to claim that vouchers uniquely raise ethical concerns. Yet, one ought to be more concerned about the factual as well as the ethical basis for a system of financial incentives to kidney donors that Matas recommended recently, when the ground for his proposal is that the attempts made in the past 2 decades "to increase the number of both living donors . . . and deceased donors" have produced "little change in the number of donated kidneys." 4 In fact, between 2000 and 2020, the number of deceased donor kidney transplants more than doubled (from 8126 to 17 583), which is hardly "little change." Anyone who wants to see an increase in kidney transplants from living donors, which rose from 5505 in 2000 to a record 7397 in 2019 before the COVID-19 pandemic reduced donations in 2020, should support an expansion of the voucher system rather a trial of paying donors. The ethical concerns raised by paying financial incentives, a radical departure from the norms that have guided organ donation for more than half a century, far exceed any implicated by voucher programs.

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Variations in Perceptions of Postoperative Opioid Need for Pediatric Surgical Patients

Cited by 6 publications

References 6 publications

A Novel Tool to Predict Postoperative Opioid Need after Laparoscopic Appendectomy in Children: A Step toward Evidence-Based Pain Management

A Novel Tool to Predict Postoperative Opioid Need after Laparoscopic Appendectomy in Children: A Step toward Evidence-Based Pain Management

Surgeon Perception That Opioids Are Not Needed for Young Children Postoperatively

Surgeon Perception That Opioids Are Not Needed for Young Children Postoperatively—Reply

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