K. Hope Wilkinson1, K. Somers2, M. Lingongo2, C. Calkins1,2 1Medical College Of Wisconsin,General Surgery,Milwaukee, WI, USA 2Children’s Hospital Of Wisconsin,General Surgery,Milwaukee, WI, USA
Introduction:
Pain is an expected result of surgery, but the ideal postoperative pain management regimen after outpatient pediatric surgical procedures is not well elucidated. Furthermore, the national “opioid epidemic” has led to concern about the routine use of postoperative opioids. The aim of this study was to examine the effects of postoperative oral opioids on outcomes of pediatric patients undergoing outpatient hernia repair. We hypothesized that the use of non-opioid medications alone would provide adequate postoperative analgesia compared to those patients receiving postoperative opioids after uncomplicated pediatric herniorrhaphy.
Methods:
A retrospective chart review of all patients less than 18 years of age undergoing umbilical, inguinal and epigastric hernia repair at a single US free-standing children’s hospital during one calendar year (2017) was conducted. Patients were excluded if discharge did not occur within 24 hours of surgery. Individual physician practice dictated whether opioids were prescribed. Data extracted included age, sex, procedure, pain medications prescribed and follow-up visits within 30 days of surgery. The Wisconsin Electronic Prescription Drug Monitoring Program was queried for those patients who received an opioid prescription to determine if the prescriptions had been filled. Calls were conducted 24 to 72 hours after surgery to assess for pain control, nausea/emesis, and wound issues.
Results:
564 children were included for analysis. 68% of children received prescriptions for opioid pain medications, of which 61% were filled. The average opioid prescription was for 6.4[1-29] doses. 59% of patients answered follow up calls, 97% reported pain as controlled. 7% of parents or guardians reported nausea/emesis. Children who received and filled an opioid script 9% reported nausea/emesis versus 1% of patients who received but did not fill an opioid script (p = 0.005). 11% of children had unscheduled visit to the general surgery clinic, their pediatrician, urgent care or emergency department; but the majority of visits were not related to the procedure (viral infections, otitis media, etc). 1% of children without an opioid prescription sought care for postoperative pain. 1% of children with an opioid prescription sought care for constipation, nausea or emesis. Two children who received opioid prescriptions required re-admission for respiratory distress compared to no children who did not receive opioid scripts.
Conclusion:
Non-opioid medications are effective in controlling postoperative pain after pediatric herniorrhaphy. Routine opioid administration does improve postoperative pain management in this population and is associated with a higher rate of medication related side effects.
