Marlor Derek R, Edmundson Elizabeth, Cruz-Centeno Nelimar, Stewart Shai, Fader Jordan P, Lee Jieun, Senna Jack C, Oyetunji Tolulope A, St Peter Shawn D, Fraser Jason D
Department of Surgery, Children's Mercy Hospital, Kansas City, Missouri.
Kansas City University School of Medicine, Kansas City, Missouri.
J Surg Res. 2025 Feb;306:580-587. doi: 10.1016/j.jss.2024.12.028. Epub 2025 Feb 3.
Overprescribing of opioid pain medications can lead to adverse outcomes and contributes to the opioid crisis. We previously reported eliminating opioids in select patients. This retrospective study aimed to compare outcomes in pediatric patients undergoing laparoscopic cholecystectomy (LC) who were and were not prescribed opioid pain medications.
A retrospective review of pediatric patients <18 ys of age who underwent LC from 2016 to 2022 was performed. Patients who underwent open cholecystectomy or additional surgical procedures performed simultaneously were excluded. Patient demographics, operative details, medication usage, and postoperative complications were recorded. Patients prescribed opioid pain medication at discharge were compared to those who were treated with nonopioid pain medications (i.e., acetaminophen, ibuprofen, and ketorolac).
In total, 511 patients were included, of which 76.9% were prescribed opioids. Patients who were not prescribed opioids more commonly received intravenous ketorolac (81.4% versus 35.6%, P < 0.001), used less postoperative morphine milligram equivalents per kilogram (MME) (0.3 versus 0.4 MME/kg, P = 0.044), had lower rates of postoperative phone calls for pain (6.8% versus 18.8%, P = 0.002), and reported less pain at follow-up (6.8% versus 18.8%, P = 0.002). There were no differences in emergency department visits or hospital readmissions within 30 ds of discharge. Institutional rates of opioid prescriptions following LC decreased over the study duration (97.8% in 2016 to 28.4% in 2022, P < 0.001).
Nonopioid postoperative pain control in pediatric patients undergoing LC is well-tolerated and may be effective in reducing opioid use. In this cohort, nonopioid and opioid pain management modalities had similar postoperative hospital resource utilization. Therefore, opioid use and its resultant complications may potentially be able to be reduced.
阿片类止痛药物的过度处方会导致不良后果，并加剧阿片类药物危机。我们之前报道过在特定患者中消除阿片类药物的使用。这项回顾性研究旨在比较接受腹腔镜胆囊切除术（LC）的儿科患者中，使用和未使用阿片类止痛药物的患者的结局。
对2016年至2022年期间接受LC的18岁以下儿科患者进行回顾性研究。排除接受开腹胆囊切除术或同时进行其他外科手术的患者。记录患者的人口统计学资料、手术细节、药物使用情况和术后并发症。将出院时开具阿片类止痛药物的患者与接受非阿片类止痛药物（即对乙酰氨基酚、布洛芬和酮咯酸）治疗的患者进行比较。
总共纳入了511例患者，其中76.9%的患者开具了阿片类药物。未开具阿片类药物的患者更常接受静脉注射酮咯酸（81.4%对35.6%，P<0.001），术后每公斤体重使用的吗啡毫克当量（MME）更少（0.3对0.4 MME/kg，P=0.044），术后因疼痛致电的发生率更低（6.8%对18.8%，P=0.002），且随访时报告的疼痛更少（6.8%对18.8%，P=0.002）。出院后30天内的急诊科就诊或再次入院情况没有差异。在研究期间，LC后阿片类药物处方的机构发生率有所下降（2016年为97.8%，2022年为28.4%，P<0.001）。
接受LC的儿科患者术后使用非阿片类药物控制疼痛耐受性良好，可能有助于减少阿片类药物的使用。在这个队列中，非阿片类和阿片类疼痛管理方式的术后医院资源利用情况相似。因此，阿片类药物的使用及其导致的并发症可能有望减少。
