Abstract

Purpose

Research describing opioid misuse in children after surgery currently describes single specialties, short follow-up, and heterogeneous data not conducive to comparative discussion. Our primary objective was to quantify opioids prescribed to pediatric surgical patients on discharge from hospital. Secondary objectives were quantifying opioids remaining unused at four-week follow-up, and family attitudes to safe storage and disposal.

Methods

We conducted a prospective observational study under counterfactual consent with telephone follow-up at four weeks of children who had undergone a surgical procedure and filled an opioid prescription at The Hospital for Sick Children, Toronto, ON, Canada. Exclusion criteria included opioid use within the previous six months, history of chronic pain, or discharge to a rehabilitation facility. Pre- and post-discharge prescribing, dispensing, and consumption data were collected prospectively in addition to parental reports of home opioid use. Opioid-dosing was converted to oral morphine milligram equivalents (MME).

Results

There were 8,672 MMEs prescribed to 110 patients. Twenty-one patients were lost to follow-up, accounting for 1,416 MME. Of the remaining 7,256 MME, 67% went unused. At follow-up, 78% of unused opioid remained in the home. Most opioids were stored in an easily accessible location in the home.

Conclusion

These findings confirm overprescribing of opioids to pediatric surgical patients. Families tend not to return opioids that exceed post-discharge analgesic requirements at home and many of the reported disposal methods are unsafe. We recommend future studies focus on optimizing opioid prescriptions to meet, but not excessively surpass, home pain management requirements, and to encourage safe opioid disposal/return methods.

Trial registration

www.clinicaltrials.gov (NCT03562013); registered 7 June, 2018.

中文翻译：

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术后出院小儿阿片类药物处方的前瞻性观察性研究：实际使用量是多少？

摘要

目的

目前描述外科手术后儿童阿片类药物滥用的研究描述了单一专科，随访时间短和数据异质，不利于进行比较性讨论。我们的主要目的是量化出院时儿科手术患者处方的阿片类药物。次要目标是量化在四个星期的随访中仍未使用的阿片类药物，以及家庭对安全储存和处置的态度。

方法

我们在获得事实反对的情况下，通过电话随访对在加拿大安大略省多伦多市病童医院接受过阿片类药物处方的儿童进行了为期四周的前瞻性观察研究。排除标准包括前六个月内使用阿片类药物，有慢性疼痛史或出院到康复机构。除父母关于家庭使用阿片类药物的报告外，前瞻性收集了出院前和出院后的处方，配药和消费数据。阿片类药物剂量转换为口服吗啡毫克当量（MME）。

结果

有110例患者开出了8,672个MME。21名患者失去随访，占1,416例MME。在其余的7256个MME中，有67％未使用。随访时，仍有78％的未使用阿片类药物留在家里。大多数阿片类药物都存放在家里容易接近的地方。

结论

这些发现证实了小儿外科患者对阿片类药物的处方过多。家庭往往不会返回超出家中出院后止痛要求的阿片类药物，而且许多报道的处置方法都不安全。我们建议未来的研究重点是优化阿片类药物的处方，以满足但不超过家庭疼痛管理的要求，并鼓励安全的阿片类药物处置/返还方法。

试用注册

www.clinicaltrials.gov（NCT03562013）；注册于2018年6月7日。