Nearly half of the opioids prescribed to patients under 21 years old could be classified as high risk, based on pharmacy data from 2019. More than half of these prescriptions were written by dentists and surgeons.
To begin to combat the opioid epidemic, we need to:
– Review our prescribing patterns
– Consider the amount of opioid being prescribed and consumed
– Rethink patients’ pain management
Best Practices for Pediatric Postoperative Pain Management
We convened a multidisciplinary working group at Michigan Medicine with representatives from Surgery, Anesthesiology, Nursing, Pharmacy, Child Life, and Psychology, who provide care for patients and families after surgery. Together, we discussed concerns about postoperative pain and formulated a common message about how to best manage it. We encourage you to consider doing the same at your institution.
Michigan Medicine’s multidisciplinary working group has developed the following:
Throughout the Perioperative Pathway
Provide a consistent message about pain management and medication use, risks, storage, and disposal. Make sure that verbal and written instructions from all providers are consistent, from preoperative evaluation to postoperative follow-up. Coordinate transitions between all clinicians to establish shared expectations for postoperative recovery and pain management needs.
As early as possible before surgery, discuss expectations regarding the experience of pain, length of recovery, and functional pain management goals with the patient and family in an age-appropriate manner. Do not routinely provide opioid prescriptions intended for postoperative use prior to surgery.
Discuss with the anesthesia team how to best manage the patient’s pain in the operating room so postoperative pain is minimized. Think about using a nerve block, local anesthetic catheter, or epidural when appropriate. Administer intravenous non-opioid medications (e.g., ketorolac, acetaminophen) for management of pain before arrival in the postanesthetic care unit unless contraindicated.
Immediate Postoperative Considerations
In the recovery area, use nonpharmacologic techniques such as distraction, Child Life services, and parental presence to address pain and anxiety as soon as it is safe to do so. When appropriate, give enteral non-opioid medications if not already administered pre- or intraoperatively. If opioids are used in the recovery area, oral administration is preferred over IV administration. Consider obtaining a consult from the Pain Service if the patient’s pain is poorly relieved despite standard therapy or from the Pediatric Psychiatry Service if a new history of substance use disorder is identified in a patient.
Postoperative Discharge Considerations
Use non-opioid therapies as a primary method for pain management and include dosing of over-the-counter (OTC) medications and instructions for their use. Discuss and encourage non-pharmacologic therapies, including distraction, heat or ice, and physical therapy.