Advertisement

Children's Opioid Use at Home After Laparoscopic Appendectomy

Published:March 31, 2021DOI:https://doi.org/10.1016/j.pmn.2021.02.011

      Abstract

      Background

      To combat the opioid epidemic, prescribers need accurate information about pediatric home opioid requirements to manage acute pain after surgery. Current opioid use estimates come from retrospective surveys; this study used medication adherence technology (eCAP) to track home opioid use.

      Purpose

      To describe children's pain treatment at home after laparoscopic appendectomy, and to compare self-reported opioid analgesic use to eCAP data and counts of returned pills.

      Design

      Prospective exploratory and descriptive study

      Methods

      A convenience sample of 96 patients, 10-17 years of age, from a single urban nonprofit children's hospital consented to self-report pain treatment in 14-day diaries and use eCAP to monitor prescribed opioid use at home after laparoscopic appendectomy.

      Results

      Patients were prescribed 5-45 opioid-containing pills (mean ± standard deviation 15 ± 7.2). Of 749 opioid-containing pills prescribed to 49 patients who returned data, 689 pills were dispensed, 167.5 were used for the reason prescribed, 488 were returned to families for disposal, and 53.5 were missing. The majority of the 49 patients were opioid naïve (72%), Caucasian (64%), and male (56%), with a mean age of 14 years. Patients used 6.6 ± 6.3 opioid-containing pills by pill count and 5.6 ± 5.1 by self-report, a significant difference (p = .004). Unreported eCAP-enabled pill bottle openings typically occurred on weekends.

      Conclusion

      Medication adherence technology (eCAP) is a more rigorous method than self-report to estimate opioid needs and detect early opioid misuse. Additional rigorously designed studies of postoperative opioid use are needed to guide opioid prescribing.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pain Management Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Anderson K.T.
        • Bartz-Kurycki M.A.
        • Ferguson D.M.
        • Kawaguchi A.L.
        • Austin M.T.
        • Kao L.S.
        • Lally K.P.
        • Tsao T.
        Too much of a bad thing: Discharge opioid prescriptions in pediatric appendectomy patients.
        Journal of Pediatric Surgery. 2018; 53: 2374-2377
        • Ayoade A.
        • Oladipo I.
        Evaluation of the correlation between self-report and electronic monitoring of adherence to hypertension therapy.
        Blood Pressure. 2012; 21: 161-166
        • Baxter K.J.
        • Nguyen H.
        • Wulkan M.L.
        • Raval M.V.
        Association of health care utilization with rates of perforated appendicitis in children 18 years or younger.
        JAMA Surgery. 2018; 153: 544-550
        • Cairo S.B.
        • Calabro K.A.
        • Bowdish E.
        • Reilly C.
        • Watt S.
        • Rothstein D.H.
        Variation in postoperative narcotic prescribing after pediatric appendectomy.
        Journal of Pediatric Surgery. 2019; 54: 1866-1871
      1. Centers for Disease Control and Prevention. (2017). Annual Surveillance Report of Drug-Related Risks and Outcomes—United States, 2017. Retrieved October 13, 2020, from www.cdc.gov/drugoverdose/pdf/pubs/2017-cdc-drug-surveillance-report.pdf.

      2. Centers for Disease Control and Prevention. (2019). Annual Surveillance Report of Drug-Related Risks and Outcomes—United States, 2019. Retrieved October 13, 2020, from www.cdc.gov/drugoverdose/pdf/pubs/2019-cdc-drug-surveillancereport.pdf.

        • Chai P.R.
        • Carreiro S.
        • Innes B.J.
        • Chapman B.
        • Schreiber K.
        • Edwards R.
        • Carrico A.W.
        • Boyer E.W.
        Oxycodone ingestion patterns in acute fracture pain with digital pills.
        Anesthesia and Analgesia. 2017; 125: 2105-2112
        • Chou R.
        • Gordon D.B.
        • de Leon-Casasola O.
        • et al.
        Management of postoperative pain: a clinical practice guideline from the American Pain Society, the American Society of Anesthesiologists, and the American Society of Regional Anesthesia and Pain Medicine.
        Journal of Pain. 2016; 17: 131-157
        • Cornelius T.
        • Vois C.I.
        • Umland R.C.
        • Kronish I.M.
        Validity of the self-reported Domains Of Subjective Extent of Nonadherence (DOSE-Nonadherence) scale in comparison with electronically monitored adherence to cardiovascular medications.
        Patient Prefer Adherence. 2019; 13: 1677-1684
        • Dowell D.
        • Haegerich L.T.M.
        • Chou R
        CDC guideline for prescribing opioids for chronic pain—United States, 2016.
        JAMA. 2016; 315: 1624-1645
        • Dorkham M.C.
        • Chalkiadis G.A.
        • von Ungern Sternberg B.S.
        • Davidson A.J.
        Effective postoperative pain management in children after ambulatory surgery, with a focus on tonsillectomy: Barriers and possible solutions.
        Paediatric Anaesthesiology. 2014; 24: 239-248
        • Drug Enforcement Administration
        Disposal of controlled substances.
        Federal Register. 2012; 77 (Retrieved October 13, 2020, from): 75783-75817
        • Fischer K.
        • Hogan V.
        • Jager A.
        • von Allmen D.
        Efficacy and utility of phone call follow-up after pediatric general surgery versus traditional clinic follow-up.
        Permanente Journal. 2015; 19: 11-14
      3. Food and Drug Administration. (2020). Disposal of Unused Medicines: What You Should Know. Updated October 1, 2020. Retrieved October 13, 2020, from https://www.fda.gov/drugs/safe-disposal-medicines/disposal-unused-medicines-what-you-should-know.

        • Freedman-Weiss M.R.
        • Chiu A.S.
        • Worhunsky D.
        • et al.
        An evidence-based guideline supporting restricted opioid prescription after pediatric appendectomy.
        Journal of Pediatric Surgery. 2020; 55: 106-111
        • Gee K.M.
        • Jones R.E.
        • Nevarez N.
        • McClain L.E.
        • Wools G.
        • Beres A.L.
        No pain is gain: A prospective evaluation of strict non-opioid pain control after pediatric appendectomy.
        Journal of Pediatric Surgery. 2020; 55: 1043-1047
        • Gordon D.B.
        • deLeon-Casasola O.A.
        • Wu C.L.
        • Sluka K.A.
        • Brennan T.J.
        • Chou R.
        Research gaps in practice guidelines for acute postoperative pain management in adults: Findings from a review of the evidence for an American Pain Society Clinical Practice Guidelines.
        Journal of Pain. 2016; 17: 158-166
        • Groenewald C.B.
        Opioid-prescribing patterns for pediatric patients in the United States.
        Clinical Journal of Pain. 2019; 35: 515-520
        • Herr K.
        • Coyne P.
        • Ely B.
        • Gelinas C.
        • Manworren R.C.B
        Pain assessment in the patient unable to self-report: Clinical practice recommendations in support of the ASPMN 2019 position statement.
        Pain Management Nursing. 2019; 20: 404-417
        • Howard R.
        • Alameddine M.
        • Klueh M.
        • et al.
        Spillover effect of evidence-based postoperative opioid prescribing.
        Journal of the American College of Surgeons. 2018; 227: 374-381
        • Howard R.
        • Fry B.
        • Gunaseelan V.
        • et al.
        Association of opioid prescribing with opioid consumption after surgery in Michigan.
        JAMA Surgery. 2019; 154e184234
      4. Johnston, L.D., Miech, R.A., O'Malley, P.M., Bachman, J.G., Schulenberg, J.E., & Patrick, M.E. (2019). Monitoring the Future national survey results on drug use 1975-2018: Overview, key findings on adolescent drug use. Retrieved October 13, 2020, from https://files.eric.ed.gov/fulltext/ED594190.pdf.

      5. Johnston, L.D., O'Malley, P.M., Miech, R.A., Bachman, J.G., & Schulenberg, J.E. (2015). Monitoring the Future national survey results on drug use: 1975-2014: Overview, key findings on adolescent drug use. Retrieved October 13, 2020, from https://files.eric.ed.gov/fulltext/ED578603.pdf.

        • Kankkunen P.
        • Vehvilainen-Julkunen K.
        • Pietila A.M.
        • Halonen P.
        Is the sufficiency of discharge instructions related to children's postoperative pain at home after day surgery?.
        Scandinavian Journal of the Caring Sciences. 2003; 17: 365-372
        • Kankkunen P.
        • Vehvilainen-Julkunen K.
        • Pietila A.M.
        • Kokki H.
        • Halonen P.
        Parents’ perceptions and use of analgesics at home after children's day surgery.
        Paediatric Anaesthesia. 2003; 13: 132-140
        • Kelley-Quon L.I.
        • Kirkpatrick M.G.
        • Ricca R.L.
        • et al.
        Guidelines for opioid prescribing in children and adolescents after surgery: An expert panel opinion.
        JAMA Surgery. 2021; 156: 76-90
        • Lautz T.B.
        • Reynolds M.
        Context and significance of emergency department visits and readmissions after pediatric appendectomy.
        Journal of Pediatric Surgery. 2011; 46: 1918-1922
        • Lintula H.
        • Kokki H.
        • Vanamo K.
        Single-blind randomized clinical trial of laparoscopic versus open appendicectomy in children.
        British Journal of Surgery. 2001; 88: 510-514
        • Manworren R.C.B
        Pediatric nurses’ journeys of caring to relieve children’s post-operative pain.
        ProQuest Dissertations Publishing. 2010; : 1-357
        • Manworren R.C.B.
        • Gilson A.M
        Nurses’ role in preventing prescription opioid diversion.
        American Journal of Nursing. 2015; 115: 34-40
        • Manworren R.C.B.
        • McElligott C.D.
        • Deraska P.V.
        • et al.
        Efficacy analysis of analgesic treatments to manage children's post-operative pain after laparoscopic appendectomy: retrospective medical record review.
        AORN Journal. 2016; 103 (317.e1-317.e11)
        • McCabe S.E.
        • West B.T.
        • Teter C.J.
        • Boyd C.J.
        Medical and nonmedical use of prescription opioids among high school seniors in the United States.
        Archives of Pediatric Adolescent Medicine. 2012; 166: 797-802
        • Miech R.
        • Johnston L.
        • O'Malley P.M.
        • Keyes K.M.
        • Heard K.
        Prescription opioids in adolescence and future opioid misuse.
        Pediatrics. 2015; 136: e1169-e1177
        • Park L.G.
        • Howie-Esquivel J.
        • Dracup K.
        Electronic measurement of medication adherence.
        Western Journal of Nursing Research. 2015; 37: 28-49
        • Pruitt L.C.C.
        • Swords D.S.
        • Russell K.W.
        • Rollins M.D.
        • Skarda D.E
        Prescription vs. consumption: Opioid overprescription to children after common surgical procedures.
        Journal of Pediatric Surgery. 2019; 54: 2195-2199
        • Rabbitts J.A.
        • Zhou C.
        • Groenewald C.B.
        • Durkin L.
        • Palermo T.M.
        Trajectories of postsurgical pain in children: Risk factors and impact of late pain recovery on long-term health outcomes after major surgery.
        Pain. 2015; 156: 2383-2389
        • Reid G.J.
        • Hebb J.P.
        • McGrath P.J.
        • Finley G.A.
        • Forward S.P.
        Cues parents use to assess postoperative pain in their children.
        Clinical Journal of Pain. 1995; 11: 229-235
        • Sarda S.
        • Short H.L.
        • Hockenberry J.M.
        • McCarthy I.
        • Raval M.V.
        Regional variation in rates of pediatric perforated appendicitis.
        Journal of Pediatric Surgery. 2017; 52: 1488-1491
        • Schechter N.L.
        • Walco G.A.
        The potential impact on children of the CDC guideline for prescribing opioids for chronic pain: above all, do no harm.
        JAMA Pediatric. 2016; 170: 425-426
        • Schmelzer T.M.
        • Rana A.R.
        • Walters K.C.
        • Norton H.J.
        • Bambini D.A.
        • Heniford B.T.
        Improved outcomes for laparoscopic appendectomy compared with open appendectomy in the pediatric population.
        Journal of Laparoendoscopic and Advanced Surgical Techniques. 2007; 17: 693-697
        • Short H.L.
        • Parakati I.
        • Heiss K.F.
        • Wulkan M.L.
        • Sweeney J.F.
        • Raval M.V.
        Challenge of balancing duration of stay and readmissions in children's operation.
        Surgery. 2017; 162: 950-957
        • Somme S.
        • Bronsert M.
        • Morrato E.
        • Ziegler M.
        Frequency and variety of inpatient pediatric surgical procedures in the United States.
        Pediatrics. 2013; 132: e1466-e1472
        • Tomecka M.J.
        • Bortsov A.V.
        • Miller N.R.
        • et al.
        Substantial postoperative pain is common among children undergoing laparoscopic appendectomy.
        Paediatric Anaesthesiology. 2012; 22: 130-135
        • Toomey S.L.
        • Peltz A.
        • Loren S.
        • et al.
        Potentially preventable 30-day hospital readmissions at a children's hospital.
        Pediatrics. 2016; 138e20154182
        • Twycross A.
        • Finley G.A.
        Children's and parents’ perceptions of postoperative pain management: a mixed methods study.
        Journal of Clinical Nursing. 2013; 22: 3095-3108
        • Twycross A.M.
        • Williams A.M.
        • Finley G.A.
        Surgeons’ aims and pain assessment strategies when managing paediatric post-operative pain: a qualitative study.
        Journal of Child Health Care. 2015; 19: 513-523
        • Van Kuiken D.M.
        • Lin L.
        • Huth M.M.
        The difficulties of studying children's pain at home.
        Western Journal of Nursing Research. 2007; 29: 432-447
      6. Wong-Baker FACES Foundation (2020). Wong-Baker FACES® Pain Rating Scale. Retrieved 2011 with permission from http://www.WongBakerFACES.org. Originally published in Whaley & Wong's Nursing Care of Infants and Children. Elsevier Inc.