Facing the Opioid Epidemic: Understanding and Better Managing Pediatric Post-Operative Pain
Jaime L. Bernstein, MD1, Kathryn Schlechtweg, MD2, Natalia Fullerton, MD1, Thomas Imahiyerobo, MD, FAAP, FACS2.
1NewYork-Presbyterian-Cornell/Columbia, New York, NY, USA, 2NewYork-Presbyterian-Columbia, New York, NY, USA.
Background:Overprescribing by physicians has been shown to be a major contributor to the opioid epidemic, that the pediatric population is unfortunately not immune to. Use of a prescription opioid before the age of 18 has been shown to be associated with a 33% increased risk of subsequent misuse. Although pediatric ambulatory plastic surgery patients are commonly prescribed opioids for post-operative pain control, there is a lack of evidence for their necessity. This study aims to investigate the role of prescribed narcotics in the ambulatory pediatric plastic surgery setting to guide future pain management of this vulnerable population. Methods:This is an observational, prospective study of pediatric patient pain management and its effectiveness. All assenting patients/parents of pediatric plastic surgery patients, ages 0-17, who underwent an ambulatory procedure by one attending surgeon from March 2018-June 2019, were asked to participate in the study. A questionnaire was developed to interrogate post-operative pain, its management, and narcotic use and distributed at the first post-operative visit. T-test and univariate analysis were used for data analysis. Results:78 patients participated in the study, 34%(46) males and 66%(54) females. Average patient age was 8 years old(1-17). 88%(67) of patients filled their narcotic medication prescription with 35%(27) taking at least one dose of narcotics, and only 9%(7) taking four or more doses. Patients overall found no difference in efficacy of the narcotics versus non-prescription analgesics(4.2/5 and 4.4/5, p=0.40). Univariate analysis found no significant difference in the amount of narcotic used based on gender or age(OR 1.0, p=0.58 and OR 0.90, p=0.09, respectively). However, patients who underwent simple soft tissue lesion excisions were less likely to use narcotic pain medication compared to all other procedures(OR 0.21 CI 0.05-0.82 p=0.03). Zero patients properly disposed of their excess narcotics, with 40%(27) storing the extra in their home. Conclusion:This study demonstrates that the majority of pediatric ambulatory plastic surgery patients do not require narcotic pain medications and experience adequate pain relief with over the counter analgesics. Using this data, we can begin to predict the type of surgery in which patients will require narcotics post-operatively and how many doses will be needed to avoid excess. Importantly, education on proper disposal of narcotic medications may be a simple, yet effective target to decrease opioid availability for abuse. In an age of opioid misuse, this research deepens our understanding of post-operative pain in ambulatory pediatric plastic surgery patients and serves to guide future interventions.
Back to 2019 Abstracts