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The association of intraoperative opioid dose with postanesthesia care unit outcomes in children: a retrospective study

Association entre la dose peropératoire d’opioïdes et les issues en salle de réveil chez les enfants : une étude rétrospective

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Abstract

Purpose

In children, the relationship between the dose of intraoperative opioid and postoperative outcomes is unclear. We examined the relationship between intraoperative opioid dose and postanesthesia care unit (PACU) pain scores and opioid and antiemetic administrations.

Methods

We performed a single-institution retrospective cohort study. Patients who were aged < 19 yr, had an American Society of Anesthesiologists Physical Status of I–III, were undergoing one of 11 procedures under general anesthesia and without regional anesthesia, and who were admitted to the PACU were included. Patients were analyzed by quartiles of total intraoperative opioid dose using multivariable regression, adjusting for confounders including procedure. An exploratory analysis of opioid-free anesthetics was also performed.

Results

Three thousand, seven hundred and thirty-three cases were included, and the mean age of included patients was 8.3 yr. After adjustment, there were no significant differences between the lowest and higher quartiles for first conscious pain score, mean pain score, PACU opioid dose, or PACU length of stay; in addition, estimated differences were small. Patients in higher quartiles were estimated to be more likely to receive antiemetics, significantly so for those in the second quartile. Patients in the lowest quartile received significantly more intraoperative nonopioid analgesics. In the exploratory analysis, no significant difference in PACU pain scores was found in cases without intraoperative opioids.

Conclusions

Children who received lower doses of intraoperative opioids did not have worse PACU pain outcomes but required fewer antiemetics and received greater numbers of nonopioid analgesics intraoperatively. These findings suggest that lower doses of intraoperative opioids may be administered to children as long as other analgesics are used.

Résumé

Objectif

Chez les enfants, la relation entre la dose peropératoire d’opioïdes et les issues postopératoires n’est pas claire. Nous avons examiné la relation entre la dose peropératoire d’opioïdes, les scores de douleur en salle de réveil, et les administrations d’opioïdes et d’antiémétiques.

Méthode

Nous avons réalisé une étude de cohorte rétrospective dans un seul établissement. Nous avons inclus les patient·es âgé·es < 19 ans ayant un statut physique ASA de I-III et bénéficiant de l’une de 11 interventions sous anesthésie générale et sans anesthésie régionale, et qui avaient été admis·es en salle de réveil. Les patient·es ont été analysé·es par quartiles de la dose totale d’opioïdes peropératoires en utilisant une régression multivariée, en ajustant les données pour tenir compte des facteurs de confusion, notamment de l’intervention. Une analyse exploratoire des anesthésiques sans opioïdes a également été réalisée.

Résultats

Au total 3733 cas ont été inclus, et l’âge moyen des enfants était de 8,3 ans. Après ajustement, il n’y avait pas de différences significatives entre les quartiles inférieur et supérieur pour le premier score de douleur chez l’enfant conscient·e, le score de douleur moyen, la dose d’opioïdes en salle de réveil ou la durée du séjour en salle de réveil; de plus, les différences estimées étaient faibles. On a estimé que les patient·es des quartiles supérieurs étaient plus susceptibles de recevoir des antiémétiques et ce, de manière significative pour ceux et celles du deuxième quartile. Les patient·es du quartile inférieur ont reçu significativement plus d’analgésiques non opioïdes peropératoires. Dans l’analyse exploratoire, aucune différence significative dans les scores de douleur en salle de réveil n’a été trouvée dans les cas sans opioïdes peropératoires.

Conclusion

Les enfants qui ont reçu des doses plus faibles d’opioïdes peropératoires n’ont pas eu de pires issues de douleur en salle de réveil, mais ont eu besoin de moins d’antiémétiques et ont reçu un plus grand nombre d’analgésiques non opioïdes en peropératoire. Ces résultats suggèrent que des doses plus faibles d’opioïdes peropératoires peuvent être administrées aux enfants tant que d’autres analgésiques sont utilisés.

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Author contributions

Michael R. King contributed to the conception and design of this study, analysis and interpretation of the data, and drafting the article. Elizabeth De Souza and Thomas A. Anderson contributed to the conception and design of this study, the acquisition, analysis and interpretation of data, and drafting the article.

Acknowledgements

The authors would like to thank Ellen Wang, MD, Clinical Associate Professor, Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children's Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA for assistance with electronic medical record data management.

Disclosures

The authors have no conflicts of interest to disclose.

Funding

All research was performed using institutional funds alone.

Prior conference presentations

This work was presented at the 2022 Society for Pediatric Anesthesia and the American Academy of Pediatrics Spring Meeting (1–3 April, Tampa, Florida, USA) and the 2022 Association of University Anesthesiologists Annual Meeting (virtual).

Editorial responsibility

This submission was handled by Dr. Philippe Richebé, Associate Editor, Canadian Journal of Anesthesia/Journal canadien d’anesthésie.

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Authors and Affiliations

  1. Department of Pediatric Anesthesiology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Michael R. King MD

  2. Department of Anesthesiology, Perioperative and Pain Medicine, Lucile Packard Children’s Hospital Stanford, Stanford University School of Medicine, Stanford, CA, USA

    Elizabeth De Souza MSc, PhD & Thomas A. Anderson MD, PhD

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  1. Michael R. King MD
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  2. Elizabeth De Souza MSc, PhD
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Correspondence to Michael R. King MD.

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King, M.R., De Souza, E. & Anderson, T.A. The association of intraoperative opioid dose with postanesthesia care unit outcomes in children: a retrospective study. Can J Anesth/J Can Anesth 71, 77–86 (2024). https://doi.org/10.1007/s12630-023-02612-1

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