Isabel Hageman

60 statements · 2 topics

Inguinal Hernia · guest expert

Featured statements

There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults.
guideline · Inguinal Hernia
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.
opinion · Inguinal Hernia
Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients.
clinical · Pain
There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients.
opinion · Pain

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Isabel's statements about Inguinal Hernia 30 statements

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PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman

Statement Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients. Open
Statement There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults. Open
Statement The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne. Open
Statement Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids. Open
Statement 20% of patients received opioids intraoperatively, which was mostly fentanyl. Open
Statement Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter. Open
Statement 33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids. Open
Statement No patients received an opiate prescription at discharge. Open
Statement Increasing age increased the risk for postoperative and total opiate use. Open
Statement There was a significant association between female sex and total opioid use. Open
Statement Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids. Open
Statement Addition of regional blocks significantly lowered postoperative opiate use. Open
Statement General anesthesia was found to be a risk for total, but not postoperative opioid use. Open
Statement Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world. Open
Statement There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients. Open
Statement Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional. Open
Statement 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. Open
Statement Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU. Open
Statement General anesthesia was a risk factor for opioid use in general. Open
Statement The institution is moving towards more spinals only for inguinal hernia repairs. Open
Statement 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. Open
Statement 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. Open
Statement All patients in the study were open inguinal hernia patients, not laparoscopic. Open
Statement 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. Open
Statement 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. Open
Statement There was no institutional education around opioid prescription at the time of the study or before. Open
Statement 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. Open
Quotation I honestly find that super interesting because this is such a young population. So it's interesting to see that even in this young population, females have higher opioid dose requirements than males Open
Statement 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. Open
Statement In the very young study population where there is no verbal communication about pain, it is especially interesting that females have higher opioid requirements, and the reason is unclear. Open
Isabel's statements about Pain 30 statements

Open the Pain collection →

PAPS -Perioperative Opioid Use In Paediatric Inguinal Hernia Patients- A Systematic Review And Retrospective Audit Of Practice - Isabel Hageman

Statement Opioids can have serious side effects and increase the risk for representation to the emergency department and future opioid misuse in pediatric surgical patients. Open
Statement There are no procedure-specific guidelines for opiate use in pediatric patients like there are in adults. Open
Statement The study included 150 pediatric patients who underwent inguinal hernia repair between May and December 2019 at Royal Children's Hospital Melbourne. Open
Statement Patients were excluded if they underwent another procedure simultaneously or had an allergy or contraindication for opioids. Open
Statement 20% of patients received opioids intraoperatively, which was mostly fentanyl. Open
Statement Post-operatively, 17% received opioids, which was mostly fentanyl in the PACU and oxycodone thereafter. Open
Statement 33% of patients received opioids during their entire hospital stay and were significantly older than patients who didn't receive opioids. Open
Statement No patients received an opiate prescription at discharge. Open
Statement Increasing age increased the risk for postoperative and total opiate use. Open
Statement There was a significant association between female sex and total opioid use. Open
Statement Preoperative paracetamol did not reduce opioid use, nor did it lower the doses in patients that did receive opioids. Open
Statement General anesthesia was found to be a risk for total, but not postoperative opioid use. Open
Statement Addition of regional blocks significantly lowered postoperative opiate use. Open
Statement Opioids play a limited role in the pain regimens at the RCH contrary to other parts of the world. Open
Statement There was wide variation in doses in patients that did receive opioids, which might be because pain assessment is difficult in young patients. Open
Statement Patients with regional anesthesia only had much lower doses than patients with general anesthesia, with or without the addition of a regional. Open
Statement 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. Open
Statement Elective inguinal hernia patients are only admitted for a couple of hours and go home straight from the PACU. Open
Statement General anesthesia was a risk factor for opioid use in general. Open
Statement The institution is moving towards more spinals only for inguinal hernia repairs. Open
Statement 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. Open
Statement 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. Open
Statement All patients in the study were open inguinal hernia patients, not laparoscopic. Open
Statement 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. Open
Statement 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. Open
Statement There was no institutional education around opioid prescription at the time of the study or before. Open
Statement 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. Open
Quotation I honestly find that super interesting because this is such a young population. So it's interesting to see that even in this young population, females have higher opioid dose requirements than males Open
Statement 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. Open
Statement In the very young study population where there is no verbal communication about pain, it is especially interesting that females have higher opioid requirements, and the reason is unclear. Open