Is there a need for narcotics following pediatric ambulatory surgery?
Casey Seideman, MD, Wayland Wu, MD, Vinaya Vasudevan, MD, Sandeep Gurram, MD, Samir Derisavifard, MD, Patrick Samson, MD, Ronnie Fine, MD, Jordan Gitlin, MD, Lane Palmer, MD.
Long Island Jewish - Cohen's Children's Medical Center, Lake Success, NY, USA.
Is there a need for narcotics following pediatric ambulatory surgery?
Casey A Seideman, Wayland Wu, Vinaya Vasudevan, Sandeep Gurram, Samir Derisavifard, Patrick Samson, Ronnie G Fine, Jordan Gitlin and Lane S Palmer
Introduction
Preemptive regional or local block provides a means of reducing post-operative analgesia and yet narcotics, non-steroidal anti-inflammatory drugs (NSAIDs), acetaminophen, or a combination thereof, are commonly prescribed or recommended for pain after the block wears off. Due to the associated adverse effects and cost of prescription narcotic drugs, we sought to evaluate analgesic usage among children undergoing ambulatory urologic surgery.
Method
We prospectively evaluated the extent of pain and subsequent analgesic use among boys undergoing same day penile (e.g. circumcision, chordee repair) or groin surgery. Boys who did not receive a caudal because of contraindications (e.g. spinal dysrhaphism, age, etc) or parent declination received intra-operative local blockade. Parents tracked pain (Wong-Baker FACES pain scale) and analgesic usage on a form provided in PACU. Doses of NSAIDs, acetaminophen or narcotics prescribed at the discretion of the operating physician were charted over the first two postoperative days. . Descriptive statistics and chi-square/Fisher’s Exact Test analyses were used for comparison testing, a two sample t-test compared pain scores between groups.
Results
161 boys, median age 36 mo (5-216mo), had complete data for analysis. Penile surgery was performed more commonly (61% vs. 39%). A caudal or local block was used in 97% of cases. Narcotics were prescribed in 102 (63%) of cases and was associated with older age (74mo vs 28mo) p <0.000. Among patients prescribed narcotics, 75% used pain medication (narcotic or non-narcotic) on day of surgery (DOS). Narcotics were used in 55 cases (54%) on DOS of which 41 took 1 dose. Narcotic usage declined to 30% on post-operative day (POD) 1 and 11% by POD 2. Overall medication usage in this group declined to 64% and 31% on POD1 and 2 respectively. Among boys without narcotic prescription, 61% had at least 1 dose of acetaminophen and/or NSAID on DOS; usage declined to 54% on POD 1, and to 36% on POD2.
Patients who underwent groin surgery were older, and utilized more medication on DOS. Older patients showed a trend of utilizing more medication (p=0.053). There was no difference in narcotic or non-narcotic requirement on DOS for caudal or local block, nor mean pain scores on DOS between narcotic (3.7) and non-narcotic (3.2) groups (Table 1).
Conclusions
Our data demonstrate similar rates of analgesic use on DOS between narcotic and non- prescription groups. This suggests that only limited amount of narcotics is needed with the majority requiring only 1 dose on DOS. Older patients were more likely to be prescribed narcotics, and may perhaps be more
likely to take medication on DOS. Given the similarity in pain scales between groups, non-narcotic analgesia may be favored which avoids high cost and potentially harmful side effects.
| Narcotic Use / All meds use | Non-Narcotic | P value | |
| Median Age | 74 mo | 28mo | p<0.00 |
| Groin surgery (median age 60mo) Penile surgery (median age 24mo) | 47 (74%) 54 (55%) | 16(26%) 44 (45%) | p=.014 (pain med usage) p=0.011 (age) |
| Caudal | 25% | 61% | p=0.707 |
| DOS use | 54% /75% | 61% | p=0.602 |
| POD 1 use | 30%/64% | 54% | p=0.154 |
| POD 2 use | 11%/31% | 36% | p=0.354 |
| DOS mean pain score | 3.7 | 3.2 | p=0.44 |
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