Abstract
Background
In the midst of our national opioid crisis, recommendations have encouraged judicious
stewardship of opioid prescription through the expanded use of non-opioid analgesic
medications. This study aims to characterize trends in perioperative pain medication
use for children undergoing ambulatory operations.
Methods
A cross-sectional, retrospective review was conducted using the Pediatric Health Information
System. Patients younger than 18 years of age who underwent ambulatory surgery during
2010 to 2017 by one of five surgical subspecialties (otolaryngology, general pediatric,
plastic or reconstructive, orthopedics, and urology) were included. Medications were
identified using Current Procedural Terminology codes based on billing information
for 18 commonly used analgesics along with the route of administration during their
encounter.
Results
A total of 1,795,329 patients with a median age of 10 years were identified, of whom
84.3% received an opioid or non-opioid analgesic. Opioid use in the perioperative
setting for ambulatory procedures decreased during the study period from 74.9% to
66.9% as a proportion of total analgesic prescriptions. Among opioids commonly used,
intravenous morphine decreased the most from 19.8% to 15.4%, and intravenous hydromorphone
and oral oxycodone use remained largely unchanged. Conversely, non-opiate medications
increased, specifically intravenous ketorolac from 8.4% to 13.6%, and intravenous
acetaminophen use increased from 0% to 8.5%. Intravenous acetaminophen use more than
doubled between 2013 and 2017 (3.4% to 8.2%) and was accompanied by a decrease in
oral acetaminophen use (14.4% to 9.3%).
Conclusion
Overall, perioperative opioid utilization appears to be decreasing in favor of non-opioid
analgesics. Other trends, such as increased intravenous acetaminophen, raise concerns
for the cost effectiveness of perioperative analgesia and resource utilization.
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Article info
Publication history
Published online: May 21, 2019
Accepted:
April 2,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
