Faculty Collaboration Database

Pediatric Outcomes following Cranial Vault Remodeling with Restricted Use of Postoperative Narcotics: A Retrospective Review. Plast Reconstr Surg 2022 Dec 01;150(6):1293e-1299e

Date

09/21/2022

Pubmed ID

36126212

DOI

10.1097/PRS.0000000000009696

Scopus ID

2-s2.0-85143088305 (requires institutional sign-in at Scopus site)

Abstract

BACKGROUND: The appropriate use of narcotics for postoperative pain control is controversial because of potential medication-induced complications. The authors sought to determine the effects of narcotics in the pediatric population following cranial vault remodeling operations.

METHODS: A retrospective review was performed on 160 consecutive patients who underwent cranial vault remodeling for craniosynostosis.

RESULTS: There was a statistically significant difference in total morphine equivalents in the group that experienced no emesis and those with at least one episode of emesis (0.97 morphine equivalents/kg versus 1.44 morphine equivalents/kg; p = 0.05). There was a statistically significant difference in hospital morphine equivalents in the group with documented respiratory events (average, 2.3 morphine equivalents/kg versus 1.3 morphine equivalents/kg in the nonevent group; p = 0.006). The patients who received dexmedetomidine had a trend toward a decrease in hospital narcotic administration with equivalent pain control (1.2 morphine equivalents/kg versus 1.9 morphine equivalents/kg; p = 0.09). There was a statistically significant positive correlation between total morphine equivalents for the hospitalization and hospital stay ( r = 0.27, p = 0.001). The amount of morphine equivalents used in the first 24 hours was also found to be an independent predictor of a respiratory event ( p = 0.002 by multivariate logistic regression). Independent positive predictors of hospital stay were age ( p < 0.001), intensive care unit time ( p < 0.001), and total morphine equivalents for the hospitalization ( p = 0.001) by multivariate analysis with linear regression.

CONCLUSION: The authors' study demonstrates improvement in outcomes with decreased use of narcotics, which establishes that there is a need to further explore postsurgical recovery outcomes with multimodal pain control.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.

Author List

Smith KJ, Cimaroli S, Loo R, Havlik RJ, Denny AD, Klement KA

Authors

Robert Havlik MD Chair, Professor in the Plastic Surgery department at Medical College of Wisconsin
Kristen Ann Klement MD Associate Professor in the Plastic Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Analgesics, Opioid
Child
Humans
Morphine
Narcotics
Pain Management
Pain, Postoperative
Retrospective Studies