OPIOID PRESCRIPTION PATTERNS AND FACTORS AFFECTING PAIN CONTROL AFTER PAEDIATRIC KNEE ARTHROSCOPIC SURGERY: A RETROSPECTIVE COHORT STUDY
Notice bibliographique
Résumé
Effective post-operative pain management remains a challenge in the pediatric population, and opioids continue to be the mainstay of peri-operative pain management. There is limited literature on opioid prescription patterns and patient and surgical factors that affect postoperative pain in pediatric patients who undergo arthroscopic knee surgery. The objectives of this study were to perform a quantitative evaluation of peri-operative opioid administration and prescription patterns following arthroscopic knee surgery in the pediatric population and identify patient and surgical factors that affect postoperative pain control in the studied population. A retrospective chart review of patients aged 8 to 20 having undergone arthroscopic knee surgery for either meniscal repair and/or anterior cruciate ligament reconstruction over a 48-month period was conducted. Demographic data, discharge prescriptions, surgical information, and pain scores were collected. Patients/parents were called 48 hours post-operatively and asked whether their pain control was adequate or inadequate with the prescribed regimen. Patients were then separated into two groups for the statistical analysis, with the two groups being adequate pain control (pain controlled) or inadequate pain control (pain uncontrolled). One hundred and fifty-two patients (50 male) were available for phone follow-up 48 hours post-operatively and were included in the study. One hundred and twenty-three patients described their pain as controlled (PC), and 29 patients described their pain as uncontrolled (PU). Patients who described their pain as uncontrolled (PU group) were on average younger (p-value = 0.038) and lighter (p-value = 0.010) than the group who reported adequate pain control at follow-up (Table 1). There was no significant difference between the groups in opioid prescription dose at discharge (p-value = 0.065). Gender, tourniquet use, multimodal analgesia, and regional anesthesia did not significantly affect post-operative pain control at 48-hour follow-up. Isolated ACL procedures had the highest percentage of patients reporting adequate pain control at follow-up (88.9%) compared to isolated meniscus (71.4%) and concomitant ACL and meniscus procedures (78.3%) (p-value = 0.303) (Figure 1). In this study, exit opioid prescriptions (mg/dose) did not differ significantly based on age, weight, or surgery type. Identifying the factors that affect postoperative pain control in the pediatric population is essential to establish effective and evidence-based guidelines for opioid prescriptions. Patients may be receiving generic postoperative opioid prescriptions instead of prescriptions individualized to the patient. Higher doses of opioids following surgery were not associated with improved postoperative pain management. Postoperative opioid prescriptions should be tailored to individual patients and procedure types to optimize the dose of opioids prescribed to every patient. Further prospective research is warranted into multimodal pain management strategies targeting better postoperative pain control and decreased opioid use. For any figures or tables, please contact the authors directly.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».