By Christine Judge
Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS
NEJM Journal Watch
A multidisciplinary expert panel convened by the American Pediatric Surgical Association has issued comprehensive evidence-based guidelines on perioperative administration of opioids in children and adolescents. Recommendations, published in JAMA Surgery, include the following:
- Opioid-free postsurgical analgesia is recommended for certain surgical procedures (e.g., hernia repairs, myringotomy) and feasible in others (e.g., appendectomy).
- When discharge analgesics are necessary, nonopioids should be first-line therapy.
- Perioperative enteral analgesia use is recommended when clinically appropriate, as in appendectomy, tonsillectomy, and some outpatient orthopedic procedures like arthroscopy.
- Intravenous use of nonopioids (e.g., ketorolac, acetaminophen) is an opioid-sparing option, as are regional and neuraxial anesthesia techniques.
- Messaging about pain management to patients and families should be consistent from the perioperative care team.
- When opioids must be prescribed, educate patients and families on possible adverse events and their seriousness and how to respond if one occurs. Clinicians should consider providing a method of safe disposal.
- The panel endorses the FDA’s position on limiting use of tramadol and codeine in minors.