R. Amin2, K. K. Somers1, M. S. Knezevich2, M. A. Lingongo2, M. J. Arca1, D. M. Gourlay1 1Medical College Of Wisconsin,Children’s Hospital Of Wisconsin And Division Of Pediatric Surgery, Department Of Surgery,Milwaukee, WI, USA 2Medical College Of Wisconsin,Division Of Pediatric Surgery, Department Of Surgery,Milwaukee, WI, USA
Introduction: Due to implications of the opioid crisis on the pediatric population, it is imperative to better define inpatient pain management practices. We hypothesize that non-narcotic analgesics remain underutilized.
Methods: We performed an IRB-approved retrospective observational study of patients with acute appendicitis who underwent laparoscopic appendectomy from 1/1/13-12/31/15 at a Level I Children’s Surgery Center. Analgesic medication administration and timing of pain-related interventions was collected. Pouissan and logistic regression was used to analyze interventions and medication usage respectively, where p<0.05 is statistically significant.
Results: There were 608 patients, 59% were male, with median age of 12 years (range 1-20). The mean aggregate pain score (3.3 ±2.5) was unchanged over time (p=0.137). There was an increase in ibuprofen (OR 1.36, p=0.003), acetaminophen (OR 4.93, p<0.001), and single-agent narcotic (OR 13.25, p<0.001) administration. There was a decrease in intravenous narcotics (OR 0.72, p=0.009), and combination narcotics (OR 0.11, p<0.001). The overall use of inpatient narcotics decreased (OR 0.65, p<0.001) (Figure 1). The number of pain scores measured (p<0.001), narcotic administration (p<0.001), and non-pharmacologic interventions (p<0.001) were lower overnight. Overall, there was underutilization of non-narcotic medications, with no significant difference between shifts (p=0.391).
Conclusion: There has been a significant decrease in narcotic usage. Non-narcotic usage has improved, but remains underutilized. There is significant variability in the frequency of pain score assessment, medication administration, and non-pharmacologic interventions. A scheduled regimen of non-narcotic therapy while reserving narcotic medications for breakthrough pain control may help optimize pharmacologic pain control in this population.
