Innovation in Patient Care
Authors: Ranstrom Lee , McGrath Ellen , Rejtar Marketa , Hayes Nicole , Jerome Joel , Lajoie Debra , Mooney David 
Published: September 2018

This poster will provide evidence that supports a novel approach to managing postoperative pain in the pediatric laparoscopic appendectomy patient, specifically reducing with potential for eliminating the use of opioids for this patient population.

BACKGROUND

Opioid therapy has long represented the foundation of pain management postoperatively. However, as a significant and concerning increase in prescription-opioid-associated morbidity and mortality has emerged, there is an urgent need to balance adequate postoperative pain management with evidence-based prescription processes and to incorporate the use of multimodal pain management plans to both reduce opioid side effects and decrease the amount of unused opioid prescriptions that are available for diversion. Laparoscopic appendectomy for nonperforated appendicitis is among the most common operation in the pediatric population. There is an opportunity to decrease and even eliminate the use of opioids for this patient population using other modalities of pain control. This study further builds on previous work started in 2013 where we found that patients were taking far less opioids for pain than had been prescribed. This resulted in standardizing the amount of opioids prescribed in this patient population to five doses.

PURPOSE

The purpose of the study will be to describe pain control in the pediatric postoperative nonperforated appendectomy population after discharge from the hospital. Our hope is that we can show adequate pain control in this patient population, specifically using nonopioid modalities for pain control including acetaminophen and ibuprofen.

DESIGN/IMPLEMENTATION

This is a prospective cohort study. The standard clinical practice regarding the prescription of postoperative medications for pain management will be followed. Patients and their families are instructed to alternate acetaminophen and nonsteroidal anti-inflammatory drugs (Motrin) as necessary after discharge from the hospital. Parents are also offered a prescription for an opioid to fill in the event that their child had breakthrough pain (pain not relieved with acetaminophen or NSAIDs [Motrin]) and instructed to fill the opioid prescription only if they think their child needs an opioid for pain relief. Parents are instructed to keep track on their child's pain medication history on a sheet given to them detailing how many doses of acetaminophen, Motrin, or opioid doses they gave to their child. The medical record will be reviewed retrospectively to determine whether the child received an intraoperative peripheral block. The patients will be approached by the team (surgeon or nurse practitioner) when discharge prescriptions are explained. The study will be described, and the subjects/families will ask if they would participate in this study. If the subject/family consents to participate, they will receive a follow-up telephone call from a member of the team on Postoperative Day 3. In the event that the family cannot be reached on Postoperative Day 3, a follow-up call will be made on Day 4. No other contact will occur after this time. They will be contacted at the best number supplied by the family. The team member will ask about their child's pain experience and about the use of opioid and nonnarcotic pain relievers (acetaminophen and NSAIDs; see Table 1, data collection sheet). Patient education sheets will be provided per usual practice.

EVALUATION/OUTCOME

Descriptive and correlational statistics will be used for the analysis of this study. This analysis will be used to interpret the appropriateness and efficacy of utilizing this modality of treatment for pain control in this patient population with the outcome of eliminating the use of opioids for pain control.