Faculty Collaboration Database

Perioperative opiate requirements in children with previous opiate infusion. Paediatr Anaesth 2012 Mar;22(3):203-8

Date

11/11/2011

Pubmed ID

22070472

DOI

10.1111/j.1460-9592.2011.03732.x

Scopus ID

2-s2.0-84856267303 (requires institutional sign-in at Scopus site)   5 Citations

Abstract

BACKGROUND: Critically ill children often require continuous opiate infusions. Tolerance may develop requiring a weaning strategy to prevent withdrawal symptoms. These children may also require subsequent surgical procedures. This is the first study to investigate whether previously opiate-tolerant patients require higher doses of opiates for adequate pain management perioperatively.

METHODS: A retrospective study was conducted at a tertiary children's hospital to investigate whether children previously exposed to continuous opiates for 10 or more days with subsequent weaning from those opiates will have similar or increased perioperative opiate requirements when compared to opioid-naïve controls. Study patients included 31 children with previous continuous opiate exposure for 10 or more days followed by weaning and without signs of withdrawal for at least 72 h prior to the surgical procedure. Excluded were patients over 18 years of age, those whose surgical procedures would be unlikely to require perioperative opiates, oncological patients, burn patients, neurologically devastated patients, and patients who received regional anesthesia in addition to perioperative narcotics. The control group consisted of 31 age- and case-matched opiate-naïve patients who underwent a surgical procedure during a similar time frame as the study patient. The medication administration record was reviewed for the length of continuous opiate exposure, date of last opiate use prior to a subsequent surgical procedure, and opiate use during the perioperative period. Opiate use was calculated as morphine equivalents per kilogram body weight (MSEQ·kg(-1)). The Wilcoxon rank sum test was used for univariate comparisons between matched pairs, and P-values <0.05 were considered statistically significant.

RESULTS: The perioperative opiate requirements in opiate-exposed patients (median, interquartile range: 0.14, 0.08-0.25 MSEQ·kg(-1)) were not significantly different from opiate-naïve patients (median, interquartile range 0.10, 0.05-0.2 MSEQ·kg(-1), P = 0.19). Pain scores indicated that patients were generally comfortable in the perioperative period.

CONCLUSIONS: The perioperative opiate requirements of pediatric patients who were successfully weaned after prolonged opiate use were similar to opiate-naïve patients. A history of prolonged opiate use alone does not necessitate special pain management for future procedures.

Author List

Fanning JJ, Stucke AG, Christensen MA, Cassidy LD, Berens RJ

Authors

Richard J. Berens MD Professor in the Anesthesiology department at Medical College of Wisconsin
Laura Cassidy PhD Associate Dean, Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Astrid G. Stucke MD Professor in the Anesthesiology department at Medical College of Wisconsin

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

Analgesics, Opioid
Child
Child, Preschool
Critical Illness
Drug Tolerance
Female
Fentanyl
Hospitals, Pediatric
Humans
Infant
Infusions, Intravenous
Male
Morphine
Pain Management
Pain Measurement
Pain, Postoperative
Perioperative Care
Retrospective Studies
Substance Withdrawal Syndrome