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Opioids for Children/Adolescents Postsurgery

Addressing the Unique Needs of Children Who Require Surgery

A team of multidisciplinary healthcare experts and opioid stewardship leaders have provided new opioid guidelines for children and adolescents postsurgery. Their recommendations are published in JAMA Surgery. Lorraine Kelley-Quon, MD, MSHS, a pediatric surgeon, and a diverse team of healthcare providers reviewed relevant literature from January 1, 1988, to February 28, 2019. Over 14,500 articles were screened, and 217 included for qualitative synthesis. To develop the guideline, the committee reviewed:

1. What are the risks of opioid misuse, diversion, heroin use, and conversion to long-term use in the pediatric population?

2. What nonopioid regimens are effective to manage postoperative pain in children (oral, intravenous and regional)? Relatedly, what procedures do not require opioids for postoperative recovery, and what are the FDA black box warnings for tramadol and codeine?

3. What teaching or preparation regarding opioid use and perioperative pain management after surgery should be provided to patients and families?

The committee outlined 20 guidelines for safer pain management in children and adolescents, among them:

1. A significant proportion of adolescents with access to opioids misuse them.

2. Of adolescents who misuse prescription opioids, a significant number will develop dependence or opioid use disorders.

 

Read the journal article.

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