Surgeons Overprescribe Opioids to Adolescents After Surgery

Pediatric orthopaedic surgery patients may receive greater quantities of opioids than necessary, a new report has found.

A total of 81 pediatric patients (mean age, 6.1 years; 62% male) were treated for a supracondylar humeral fracture with closed reduction and percutaneous pinning at a single institution. Most patients (53.1%) had Type-II fractures, and the rest had Type-III fractures. Researchers used the Wong-Baker FACES Pain Rating Scale to measure pain, and they collected data on postoperative opioid usage days one through seven, 10, 14, and 21.

The highest reported pain levels occurred on arrival to the emergency department (mean 3.5 points) and the morning of the first postoperative day (mean 3.5 points). By the third day, the mean pain score was 1.8 points, with mean opioid doses down to less than one dose.

Patients used just under a quarter (24.1%) of their prescribed opioids; 18 patients did not take opioids at all after they were discharged, and an additional 18 took over-the-counter medications, including ibuprofen. By day 10, only 11 patients were still taking analgesic medication; after two and three weeks, just six and four patients, respectively, were taking over-the-counter medications. Fracture classification, age, and sex did not significantly impact pain rating or use of opioids.

“When we’re prescribing analgesic opioids for young patients, we not only want to avoid overtreating this group of patients, but we also want to make sure we’re not undertreating pain as they recover from surgery,” said lead study author Apurva Shah, MD, MBA, an orthopaedic surgeon at Children’s Hospital of Philadelphia and co-director of the Brachial Plexus Injury Program, in a press release.

“This study suggests that orthopaedic surgeons really need to think about our current prescribing practices and how we can help decrease the potential for overprescription and opioid diversion,” Shah said. “Based on this study, which we believe can be applied to other common types of orthopaedic injuries, a prescription for a much shorter period of time seems to be appropriate.”

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Sources: The Journal of Bone and Joint Surgery, Children’s Hospital of Philadelphia