Pediatric Pain and Pain Management After Ambulatory Plastic Surgery: Trends in the Age of Opioid Awareness.
Jaime L. Bernstein, MD, Natalia Fullerton, MD, Katheryn A. Schlechtweg, BS, Thomas A. Imahiyerobo, MD.
NewYork-Presbyterian Cornell and Columbia, New York, NY, USA.
BACKGROUND:Post-operative pain in pediatric ambulatory surgical patients is a major contributor to surgical morbidity and its importance has become increasingly recognized. Currently, it is common to prescribe pediatric patients opioids for post-operative pain control, even though there is a lack of evidence for their use in pediatric ambulatory surgery. Given the current opioid epidemic in the United States, clinical opioid use is becoming an important area of research, but there is still a paucity of literature on pediatric surgical patients, particularly in the field of plastic surgery. This current work aims to better understand post-operative pain and resulting use of opioids, along with other pain management modalities, in the ambulatory plastic surgery pediatric patient population.
METHODS:This is an observational study of patient pain and pain management practices. All assenting patients and parents of pediatric plastic surgery patients, ages 0-18, who underwent an ambulatory procedure by one attending surgeon since March 2018, were asked to participate in the study. A questionnaire was developed to interrogate post-operative pain, prescription use, and pain management practices, which was given at the first post-operative clinic visit. Supplemental clinical data, including specifics of the surgery, underlying disease, demographic information, was obtained from patient charts. Multivariate analysis was performed to identify significant contributing factors of inadequate pain control and narcotic use.
RESULTS:The average patient age was 8.6 years, with 54% males and 46% females enrolling in the study. All patients were prescribed a form of narcotic medication, on average 5 days worth. The average number of days of analgesic use was 3.2 days. Although 70% of patients filled the opioid prescription, only 30% used some amount of narcotic medication post-operatively, with only 8% of patients reporting the need to use an opioid medication more than 4 times after discharge. 85% of patients were able to achieve adequate analgesia using non-narcotic pharmacologics. Only 25% of patients knew how to properly dispose of the left over prescription medication.
CONCLUSIONS:This study demonstrates that most pediatric patients will have sufficient pain relief without narcotic medications. Additionally, education on proper disposal of narcotic medications may be a simple and effective target to decrease opioid availability for abuse. In an era of opioid abuse and misuse, which has been propagated by clinician's opioid prescription practices, this research deepens the physicians' understanding of post-operative pain management in pediatric plastic surgery ambulatory patients and serves to guide future pain management and narcotic regimens.
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