New pediatric guidelines for perioperative opioid use

  • Cravero JP & al.
  • Paediatr Anaesth
  • 31/03/2019

  • Kelli Whitlock Burton
  • Clinical Essentials
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Takeaway

  • The Society for Pediatric Anesthesia has published guidelines for the administration of opioids in pediatric patients during the perioperative period.

Why this matters

  • There are few evidence-based reports offering guidance on opioid use in children in the perioperative period.

Key recommendations

  • No increased risk of respiratory distress because of opioids for term infants (>3 months) compared with older children and adults at the same blood concentration of opioid.
  • Intramuscular administration of opioids is not recommended for primary pain control.
  • Meperidine is not recommended for patient-controlled analgesia postoperative pain control because of increased risk of accumulation of toxic metabolites that may cause seizures.
  • Codeine is not recommended for children and nursing mothers as a postoperative analgesic, and tramadol may not be appropriate for patients
  • Opioid weaning in patients with chronic pain who undergo surgery to remove the source of the pain should be monitored by pain medicine specialists.
  • Opioid dosing in patients with obstructive sleep apnea (OSA) and/or obesity should be based on ideal or lean body weight, and the dose of opioid should be reduced by 50%-67% for OSA patients.