From the Department of Anesthesiology.
Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee.
Anesth Analg. 2022 Jan 1;134(1):133-140. doi: 10.1213/ANE.0000000000005503.
Opioid analgesics are commonly prescribed for postoperative analgesia following pediatric surgery and often result in leftover opioid analgesics in the home. To reduce the volume of leftover opioids and overall community opioid burden, the State of Tennessee enacted a policy to reduce initial opioid prescribing to a 3-day supply for most acute pain incidents. We aimed to evaluate the extent of leftover opioid analgesics following pediatric ambulatory surgeries in the context of a state-mandated restrictive opioid-prescribing policy. We also aimed to evaluate opioid disposal rates, methods of disposal, and reasons for nondisposal.
Study personnel contacted the parents of 300 pediatric patients discharged with an opioid prescription following pediatric ambulatory surgery. Parents completed a retrospective telephone survey regarding opioid use and disposal. Data from the survey were combined with data from the medical record to evaluate proportion of opioid doses prescribed that were left over.
The final analyzable sample of 185 patients (62% response rate) were prescribed a median of 12 opioid doses (interquartile range [IQR], 12-18), consumed 2 opioid doses (IQR, 0-4), and had 10 opioid doses left over (IQR, 7-13). Over 90% (n = 170 of 185) of parents reported they had leftover opioid analgesics, with 83% of prescribed doses left over. A significant proportion (29%, n = 54 of 185) of parents administered no prescribed opioids after surgery. Less than half (42%, n = 71 of 170) of parents disposed of the leftover opioid medication, most commonly by flushing down the toilet, pouring down the sink, or throwing in the garbage. Parents retaining leftover opioids (53%, n = 90 of 170) were most likely to keep them in an unlocked location (68%, n = 61 of 90). Parents described forgetfulness and worry that their child will experience pain in the future as primary reasons for not disposing of the leftover opioid medication.
Despite Tennessee's policy aimed at reducing leftover opioids, a significant proportion of prescribed opioids were left over following pediatric ambulatory surgeries. A majority of parents did not engage in safe opioid disposal practices. Given the safety risks related to leftover opioids in the home, further interventions to improve disposal rates and tailor opioid prescribing are warranted after pediatric surgery.
阿片类镇痛药常用于小儿手术后的术后镇痛，且常常导致家庭中剩余阿片类镇痛药。为减少剩余阿片类药物的数量和总体社区阿片类药物负担，田纳西州颁布了一项政策，将大多数急性疼痛事件的初始阿片类药物处方减少至 3 天供应量。我们旨在评估在州规定的限制性阿片类药物处方政策背景下，小儿门诊手术后剩余阿片类镇痛药的程度。我们还旨在评估阿片类药物的处置率、处置方法和未处置的原因。
研究人员联系了 300 名接受小儿门诊手术后携带阿片类药物处方出院的患儿的父母。父母通过回顾性电话调查完成了阿片类药物使用和处置情况的调查。将调查数据与病历数据相结合，以评估开出的阿片类药物剂量中有多少被剩余。
最终可分析的 185 名患者（62%的回复率）的中位数处方剂量为 12 剂阿片类药物（四分位距[IQR]，12-18），实际使用 2 剂（IQR，0-4），剩余 10 剂（IQR，7-13）。超过 90%（n=170/185）的父母报告他们有剩余的阿片类镇痛药，其中 83%的规定剂量被剩余。相当一部分（29%，n=54/185）的父母在手术后没有服用规定的阿片类药物。只有不到一半（42%，n=71/170）的父母处理了剩余的阿片类药物，最常见的方法是冲下马桶、倒入水槽或扔进垃圾桶。保留剩余阿片类药物的父母（53%，n=90/170）最有可能将其放在未上锁的地方（68%，n=61/90）。父母表示，健忘和担心孩子将来会感到疼痛是他们不处理剩余阿片类药物的主要原因。
尽管田纳西州的政策旨在减少剩余的阿片类药物，但小儿门诊手术后仍有相当一部分规定剂量的阿片类药物被剩余。大多数父母没有进行安全的阿片类药物处理。考虑到家中剩余阿片类药物的安全风险，在小儿手术后需要进一步采取干预措施来提高处置率和调整阿片类药物的开具。
