Dosing protocol could reduce ‘aberrant opioid behavior’ risk in pediatric surgery patients
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A standard opioid dosing protocol reduced the average number of prescribed doses at discharge among pediatric orthopedic surgery patients, according to recently presented results.
The protocol, which is based on perceived surgical magnitude, could lower the risk of “aberrant opioid behavior,” said Megan Johnson, MD, who presented findings of a postoperative opioid prescribing protocol at the Pediatric Orthopaedic Society of North America Annual Meeting, which was held as a virtual meeting.
“Unused prescription opioid medication is one of the main sources of non-medical opioid use,” Johnson said in her presentation.
“Orthopedic surgeons prescribe the third most opioid medications of any subspecialty in the United States,” Johnson said. “Without clear guidelines regarding optimal dosing and pain medication after surgery, there is wide variability in dosing patterns at discharge, which often leads to over prescribing ... as evidenced by the fact that the same amount of opioids are being prescribed for an ACL as for our patients undergoing spinal fusion surgery.”
Initial protocol implementation began in November 2017 and included 1,645 patients. Protocol adherence increased from 0% at baseline to 97%.
“The mean prescribed opioid doses following all surgical procedures were reduced by 4.1 doses,” Johnson said. “Mean opioid doses after intermediate and minor procedures were decreased by 7.1 and 4.7 doses, respectively,” she added.
“The dosing protocol was designed to be easily transferable to other pediatric orthopedic practices, and even other specialties outside of orthopedic surgery – as long as the institution is able to sort their specialty’s procedures into minimal, minor, intermediate and major categories,” Johnson said.
“Through implementation of simple protocols like this one, we can achieve a decrease in the overall number of opioids available to adolescents and – hopefully – lower the risk of our patients developing aberrant opioid behaviors and opioid use disorders,” she said.
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Ross K, et al. Paper 57. Presented at: Pediatric Orthopaedic Society of North America Annual Meeting; May 13, 2020 (virtual meeting).
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