Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion
Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking. To assemble a multidisciplinary team of health care experts and...
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| Published in: | JAMA surgery Vol. 156; no. 1; p. 76 |
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| Main Authors: | , , , , , , , , , , , , , , , , , , |
| Format: | Journal Article |
| Language: | English |
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United States
01.01.2021
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| ISSN: | 2168-6262, 2168-6262 |
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| Abstract | Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.
To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.
Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.
Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.
These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts. |
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| AbstractList | Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.
To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.
Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.
Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.
These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts. Opioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.ImportanceOpioids are frequently prescribed to children and adolescents after surgery. Prescription opioid misuse is associated with high-risk behavior in youth. Evidence-based guidelines for opioid prescribing practices in children are lacking.To assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.ObjectiveTo assemble a multidisciplinary team of health care experts and leaders in opioid stewardship, review current literature regarding opioid use and risks unique to pediatric populations, and develop a broad framework for evidence-based opioid prescribing guidelines for children who require surgery.Reviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.Evidence ReviewReviews of relevant literature were performed including all English-language articles published from January 1, 1988, to February 28, 2019, found via searches of the PubMed (MEDLINE), CINAHL, Embase, and Cochrane databases. Pediatric was defined as children younger than 18 years. Animal and experimental studies, case reports, review articles, and editorials were excluded. Selected articles were graded using tools from the Oxford Centre for Evidence-based Medicine 2011 levels of evidence. The Appraisal of Guidelines for Research & Evaluation (AGREE) II instrument was applied throughout guideline creation. Consensus was determined using a modified Delphi technique.Overall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.FindingsOverall, 14 574 articles were screened for inclusion, with 217 unique articles included for qualitative synthesis. Twenty guideline statements were generated from a 2-day in-person meeting and subsequently reviewed, edited, and endorsed externally by pediatric surgical specialists, the American Pediatric Surgery Association Board of Governors, the American Academy of Pediatrics Section on Surgery Executive Committee, and the American College of Surgeons Board of Regents. Review of the literature and guideline statements underscored 3 primary themes: (1) health care professionals caring for children who require surgery must recognize the risks of opioid misuse associated with prescription opioids, (2) nonopioid analgesic use should be optimized in the perioperative period, and (3) patient and family education regarding perioperative pain management and safe opioid use practices must occur both before and after surgery.These are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts.Conclusions and RelevanceThese are the first opioid-prescribing guidelines to address the unique needs of children who require surgery. Health care professionals caring for children and adolescents in the perioperative period should optimize pain management and minimize risks associated with opioid use by engaging patients and families in opioid stewardship efforts. |
| Author | Argo, Jonathan Harbaugh, Calista M Downard, Cynthia D Shields, Tracy Kirkpatrick, Matthew G Ricca, Robert L Kelley-Quon, Lorraine I Sola, Juan E Diefenbach, Karen A Azarow, Kenneth S Baird, Robert Kim, Eugene Garrett, Paula Mahdi, Elaa M Brady, Ashley Wills, Hale Henry, Marion C W Goldin, Adam B St Peter, Shawn D |
| Author_xml | – sequence: 1 givenname: Lorraine I surname: Kelley-Quon fullname: Kelley-Quon, Lorraine I organization: Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles – sequence: 2 givenname: Matthew G surname: Kirkpatrick fullname: Kirkpatrick, Matthew G organization: Department of Preventive Medicine, University of Southern California, Los Angeles – sequence: 3 givenname: Robert L surname: Ricca fullname: Ricca, Robert L organization: Department of Pediatric Surgery, Naval Medical Center Portsmouth, Portsmouth, Virginia – sequence: 4 givenname: Robert surname: Baird fullname: Baird, Robert organization: Division of Pediatric Surgery, British Columbia Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada – sequence: 5 givenname: Calista M surname: Harbaugh fullname: Harbaugh, Calista M organization: Department of Surgery, University of Michigan Medical School, Ann Arbor – sequence: 6 givenname: Ashley surname: Brady fullname: Brady, Ashley organization: Department of Pediatric Surgery, University of Michigan, Ann Arbor – sequence: 7 givenname: Paula surname: Garrett fullname: Garrett, Paula organization: Department of Pediatric Surgery, University of Michigan, Ann Arbor – sequence: 8 givenname: Hale surname: Wills fullname: Wills, Hale organization: Department of Surgery, Alpert Medical School, Brown University, Providence, Rhode Island – sequence: 9 givenname: Jonathan surname: Argo fullname: Argo, Jonathan organization: Department of Pediatric Anesthesiology, Warren Alpert Medical School, Brown University, Providence, Rhode Island – sequence: 10 givenname: Karen A surname: Diefenbach fullname: Diefenbach, Karen A organization: Department of Pediatric Surgery, Nationwide Children's Hospital, The Ohio State University, Columbus – sequence: 11 givenname: Marion C W surname: Henry fullname: Henry, Marion C W organization: Department of Surgery, University of Arizona College of Medicine, Tucson – sequence: 12 givenname: Juan E surname: Sola fullname: Sola, Juan E organization: Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, Florida – sequence: 13 givenname: Elaa M surname: Mahdi fullname: Mahdi, Elaa M organization: Keck School of Medicine, Department of Surgery, University of Southern California, Los Angeles – sequence: 14 givenname: Adam B surname: Goldin fullname: Goldin, Adam B organization: Department of Surgery, University of Washington School of Medicine, Seattle – sequence: 15 givenname: Shawn D surname: St Peter fullname: St Peter, Shawn D organization: Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri – sequence: 16 givenname: Cynthia D surname: Downard fullname: Downard, Cynthia D organization: Division of Pediatric Surgery, Hiram C. Polk Jr MD Department of Surgery, University of Louisville, Louisville, Kentucky – sequence: 17 givenname: Kenneth S surname: Azarow fullname: Azarow, Kenneth S organization: Division of Pediatric Surgery, Department of Surgery, Oregon Health & Science University, Portland – sequence: 18 givenname: Tracy surname: Shields fullname: Shields, Tracy organization: Division of Library Services, Naval Medical Center, Portsmouth, Virginia – sequence: 19 givenname: Eugene surname: Kim fullname: Kim, Eugene organization: Division of Pain Medicine, Department of Anesthesiology and Critical Care Medicine, Children's Hospital Los Angeles, Los Angeles, California |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/33175130$$D View this record in MEDLINE/PubMed |
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| SubjectTerms | Adolescent Age Factors Analgesics, Opioid - administration & dosage Attitude of Health Personnel Humans Pain, Postoperative - diagnosis Pain, Postoperative - drug therapy Pain, Postoperative - etiology Patient Selection Practice Guidelines as Topic Practice Patterns, Physicians |
| Title | Guidelines for Opioid Prescribing in Children and Adolescents After Surgery: An Expert Panel Opinion |
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