Risks of Opioids Should Be Recognized for Children After Surgery

THURSDAY, Nov. 12, 2020 -- Health care workers providing care to children after surgery should recognize the risks of opioids, maximize use of nonopioid analgesics, and provide education for perioperative pain management and safe opioid practices, according to an expert panel opinion published online Nov. 11 in JAMA Surgery.

Lorraine I. Kelley-Quon, M.D., from the Children's Hospital in Los Angeles, and colleagues reviewed the relevant literature to develop a framework for evidence-based opioid prescribing guidelines for children requiring surgery. A total of 217 unique articles were included for qualitative synthesis.

The researchers generated 20 guidelines, which underscore three primary themes. Health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, including a significant proportion of adolescents with access to opioids misusing them; this can lead to opioid use disorder and heroin use. Nonopioid analgesics should be optimized in the perioperative period, and opioid-free postoperative analgesia is feasible for many pediatric operations; nonopioid options are recommended as first-line treatment when discharge analgesics are deemed necessary. Finally, before and after surgery, patient and family education relating to perioperative pain management and safe opioid practices should be provided, including tailored education to the caregiver's and child's needs.

"As surgeon awareness and publications highlighting opioid stewardship increase, we anticipate updating the present guidelines to provide recommendations outlining appropriate dosing of oral morphine equivalent after specific procedures and evidence-based storage and disposal recommendations," the authors write.

Abstract/Full Text (subscription or payment may be required)

Editorial (subscription or payment may be required)

Posted: November 2020