Collection
Built automatically
From across the library
Not curated by a person
Pain
Compiled from across the library · built automatically
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults. — Isabel Hageman, PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman · 0:40
PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman
Watch →
Listen to Isabel Hageman gave her presentation of "Perioperative Opioid Use In Pediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice" at the first ever Best of the Best in Pediatric Surgery event.
video11:59 · May 2022
Acetaminophen (Tylenol) plus NSAIDs (e.g., ibuprofen/Motrin) are equally as effective as narcotics for pain relief without the side effects of headache, constipation, and nausea. Opioid over prescription: Practice Gap discussion at Update Course 2018 · 0:43
Opioid over prescription: Practice Gap discussion at Update Course 2018
Watch →
At the 6th Annual Pediatric Surgery Update Course, Drs Charles Snyder, Craig Lillehei and David Powell discussthe top ten practice gaps of 2018. Here they discuss the number one practice gap, opioid over prescription, focused on interventio
video8:27 · Sep 2018
Recognizing implicit bias is the first step; it exists in 100% of people, it's not your fault (media and society reinforce it), but you have a responsibility to behave differently. — Mary Brandt, Unconscious Bias · 30:59
Unconscious Bias
Listen →
This episode is an interactive discussion about Unconscious Bias between Dr. Todd Ponsky, Dr. Julie Freischlag, Dr. Mary Brandt, Dr. Quinn Capers IV, Dr. Alejandra (Alex) Casar Berazaluce, Dr. Rachel (Rae) Hanke, and Dr. Alexander Gibbons.
podcast58:27 · Dec 2020
Expert statements from the recordings in this collection.
PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman
Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients.
Isabel Hageman0:33
There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults.
The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne.
Isabel Hageman0:52
Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids.
Isabel Hageman0:58
20% of patients received opioids intraoperatively, which was mostly fentanyl.
Isabel Hageman1:41
Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter.
Isabel Hageman1:46
33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids.
Isabel Hageman1:53
No patients received an opiate prescription at discharge.
Isabel Hageman2:02
Increasing age increased the risk for postoperative and total opiate use.
Isabel Hageman2:06
There was a significant association between female sex and total opioid use.
Isabel Hageman2:06
Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids.
Isabel Hageman2:16
Addition of regional blocks significantly lowered postoperative opiate use.
Isabel Hageman2:23
General anesthesia was found to be a risk for total, but not postoperative opioid use.
Isabel Hageman2:23
Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world.
There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients.
Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional.
Isabel Hageman2:54
Todd has seen a big change in practice over the last decade, from giving everybody narcotics after surgery to not prescribing narcotics at all.
The median length of stay was elevated due to premature infants and children already admitted to the hospital who had inguinal hernia surgery as one reason for admission.
Isabel Hageman5:07
Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU.
Isabel Hageman5:33
General anesthesia was a risk factor for opioid use in general.
Isabel Hageman6:19
The institution is moving towards more spinals only for inguinal hernia repairs.
Matthew Mitchell in Akron has been doing cases under spinal anesthesia where patients are wide awake, don't move during surgery, don't need PACU, and go home immediately.
Todd6:46
In very young children, spinal anesthesia is easier to perform because they don't experience the potentially traumatic aspects of being in the OR as older children might.
The median age of patients in the study was 3 months, making spinal anesthesia ideal, especially since caution with narcotics is important in young children.
Isabel Hageman7:27
All patients in the study were open inguinal hernia patients, not laparoscopic.
Isabel Hageman8:23
There was no association found between length of stay and opiate use, though this may be due to the small sample size of patients who received opioids.
Isabel Hageman8:25
The study was a retrospective audit, so groups (general anesthesia only, spinal only, or both) were determined by looking back at what patients received, not selected beforehand.
Isabel Hageman8:55
There was no institutional education around opioid prescription at the time of the study or before.
Isabel Hageman9:51
Two or three years before the study, the warnings around opioids and their classification level were changed in Australia, which may have influenced opioid use at RCH.
In older populations, the theory for gender differences in opioid requirements is that males are reluctant to report pain while females will ask for painkillers.