Presenter Status
Resident/Ph.D/Post graduate (> 1 month of dedicated research time)
Abstract Type
Research
Primary Mentor
Tolulope Oyetunji, MD MPH
Start Date
17-5-2024 11:30 AM
End Date
17-5-2024 1:30 PM
Presentation Type
Poster Presentation
Description
Introduction: Patient controlled analgesia (PCA) was previously standard for postoperative pain control in children with perforated appendicitis at our institution. We previously reported the equivocal outcome of intravenous (IV) acetaminophen as a pain control adjunct used to transition from PCA to oral narcotics. We have since transitioned to a PCA-free, multi-modal pain control regimen postoperatively in perforated appendicitis. Through observational study, we aim to describe the impact of our new pain control regimen on postoperative narcotic use.
Methods: Children– June 2020 at a single freestanding children’s hospital were reviewed. Details of their hospitalization, including demographic, operative, anesthesia, pain management, and length of stay data, were collected.
Results: A total of 400 patients (56% male) underwent laparoscopic appendectomy for perforated appendicitis. The median age was 10.5 years [IQR 7.8,13.0], the majority identified as white (65%), and the median BMI was 18.7 kg/m2 [IQR 15.9,22.8]. The median hospital length of stay was 3.1 days [IQR 2.2,4.2]. Ketorolac was given intraoperatively to 78% of children while acetaminophen was given to 23%; 18% of children received both. Median pain scores were highest in the first 12 hours after surgery (median pain score 5 [IQR 3,7]). 42% (167/400) did not receive narcotics once transferred to the floor. Scheduled 48-hr IV Tylenol and Toradol were given, 384 (96%) patients received at least 1 dose of IV Toradol (7 median doses.[IQR 5,11]). 374 (94%) received at least 1 dose of IV Tylenol (7 median doses [IQR 4,8]). For those requiring additional narcotics, the median maximum daily morphine milligram equivalent (MME) was 9.5 [IQR 6.3,15]. Only 3 (0.8%) patients required escalation to PCA for uncontrolled pain. 261 (65%) of patients were discharged with an oral narcotic prescription, though 104 (40%) of those patients had not required any narcotics post-op. The median prescribed outpatient max daily MME was 30 [IQR 16.2, 30].
Conclusion: A multimodal pain regimen, including scheduled acetaminophen and ketorolac usage, in children with perforated appendicitis, is helpful in limiting narcotic use post-operatively, and may contribute to decreased LOS compared to prior studies. Protocolization of discharge pain medication prescribing is the next step to determine which children would benefit most while further reducing unnecessary narcotic exposure.
Pain Management In Perforated Appendicitis: Transitioning To A Minimal Narcotic Strategy
Introduction: Patient controlled analgesia (PCA) was previously standard for postoperative pain control in children with perforated appendicitis at our institution. We previously reported the equivocal outcome of intravenous (IV) acetaminophen as a pain control adjunct used to transition from PCA to oral narcotics. We have since transitioned to a PCA-free, multi-modal pain control regimen postoperatively in perforated appendicitis. Through observational study, we aim to describe the impact of our new pain control regimen on postoperative narcotic use.
Methods: Children– June 2020 at a single freestanding children’s hospital were reviewed. Details of their hospitalization, including demographic, operative, anesthesia, pain management, and length of stay data, were collected.
Results: A total of 400 patients (56% male) underwent laparoscopic appendectomy for perforated appendicitis. The median age was 10.5 years [IQR 7.8,13.0], the majority identified as white (65%), and the median BMI was 18.7 kg/m2 [IQR 15.9,22.8]. The median hospital length of stay was 3.1 days [IQR 2.2,4.2]. Ketorolac was given intraoperatively to 78% of children while acetaminophen was given to 23%; 18% of children received both. Median pain scores were highest in the first 12 hours after surgery (median pain score 5 [IQR 3,7]). 42% (167/400) did not receive narcotics once transferred to the floor. Scheduled 48-hr IV Tylenol and Toradol were given, 384 (96%) patients received at least 1 dose of IV Toradol (7 median doses.[IQR 5,11]). 374 (94%) received at least 1 dose of IV Tylenol (7 median doses [IQR 4,8]). For those requiring additional narcotics, the median maximum daily morphine milligram equivalent (MME) was 9.5 [IQR 6.3,15]. Only 3 (0.8%) patients required escalation to PCA for uncontrolled pain. 261 (65%) of patients were discharged with an oral narcotic prescription, though 104 (40%) of those patients had not required any narcotics post-op. The median prescribed outpatient max daily MME was 30 [IQR 16.2, 30].
Conclusion: A multimodal pain regimen, including scheduled acetaminophen and ketorolac usage, in children with perforated appendicitis, is helpful in limiting narcotic use post-operatively, and may contribute to decreased LOS compared to prior studies. Protocolization of discharge pain medication prescribing is the next step to determine which children would benefit most while further reducing unnecessary narcotic exposure.
