February 25, 2019
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Duration of opioid treatment, amount per dose declined among pediatric patients

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Ronald S. Litman

Despite a stable rate of take-home opioid prescriptions to pediatric patients undergoing outpatient surgery, results published in Pain Medicine showed a steady decline in the duration of treatment and the amount per dose from 2013 to 2017.

Ronald S. Litman , DO, and colleagues collected the incidence rate of prescribing, dose, number of doses available and maximum weight-based home opioid availability among 65,190 encounters of pediatric outpatient surgeries from 2013 to 2017 for nine surgical specialties. Researchers also collected age, sex, weight, race/ethnicity, insurance type and surgical service.

Between 2013 and 2017, results showed a range from 18% to 21% in the incidence rate of receiving a take-home opioid prescription at discharge with no clear directional trend. However, researchers noted a steady decline in the maximum available take-home dose among patients prescribed opioids, which was due to a decrease in the number of doses prescribed and, beginning in 2015, the amount per dose.

“The duration of pain treatment with opioids after surgery steadily decreased, but the more significant decrease came when external limits were placed by state regulation and insurance coverage,” Litman told Healio.com/Orthopedics. “We didn’t measure whether or not this decrease in duration led to increases in patients’ pain but other research publications have indicated that, in general, most patients do not use their entire supply.”

Patients who were more likely to receive an opioid prescription included female patients, patients with public insurance, patients who did not disclose their ethnicity and patients of ethnic minorities, according to results.

Litman noted it still needs to be determined whether lower doses of postoperative opioids and whether alternative, non-opioid treatments will provide adequate pain treatment.

“Because the relative incidence of postoperative opioid prescribing remained steady over the past 5 years, pediatric surgeons still feel that opioids are an essential part of postoperative pain management,” Litman said. “It is unknown whether or not there is room to trial other (non-opioid) methods of pain management and whether or not they would be effective as opioids.” – by Casey Tingle

 

Disclosures: The authors report no relevant financial disclosures.