OPIOID PRESCRIPTION PATTERNS AND FACTORS AFFECTING PAIN CONTROL AFTER PAEDIATRIC KNEE ARTHROSCOPIC SURGERY: A RETROSPECTIVE COHORT STUDY

Effective post-operative pain management remains a challenge in the pediatric population, and opioids continue to be the mainstay of peri-operative pain management. There is limited literature on opioid prescription patterns and patient and surgical factors that affect postoperative pain in pediatric patients who undergo arthroscopic knee surgery. The objectives of this study were to perform a quantitative evaluation of peri-operative opioid administration and prescription patterns following arthroscopic knee surgery in the pediatric population and identify patient and surgical factors that affect postoperative pain control in the studied population. A retrospective chart review of patients aged 8 to 20 having undergone arthroscopic knee surgery for either meniscal repair and/or anterior cruciate ligament reconstruction over a 48-month period was conducted. Demographic data, discharge prescriptions, surgical information, and pain scores were collected. Patients/parents were called 48 hours post-operatively and asked whether their pain control was adequate or inadequate with the prescribed regimen. Patients were then separated into two groups for the statistical analysis, with the two groups being adequate pain control (pain controlled) or inadequate pain control (pain uncontrolled). One hundred and fifty-two patients (50 male) were available for phone follow-up 48 hours post-operatively and were included in the study. One hundred and twenty-three patients described their pain as controlled (PC), and 29 patients described their pain as uncontrolled (PU). Patients who described their pain as uncontrolled (PU group) were on average younger (p-value = 0.038) and lighter (p-value = 0.010) than the group who reported adequate pain control at follow-up (Table 1). There was no significant difference between the groups in opioid prescription dose at discharge (p-value = 0.065). Gender, tourniquet use, multimodal analgesia, and regional anesthesia did not significantly affect post-operative pain control at 48-hour follow-up. Isolated ACL procedures had the highest percentage of patients reporting adequate pain control at follow-up (88.9%) compared to isolated meniscus (71.4%) and concomitant ACL and meniscus procedures (78.3%) (p-value = 0.303) (Figure 1). In this study, exit opioid prescriptions (mg/dose) did not differ significantly based on age, weight, or surgery type. Identifying the factors that affect postoperative pain control in the pediatric population is essential to establish effective and evidence-based guidelines for opioid prescriptions. Patients may be receiving generic postoperative opioid prescriptions instead of prescriptions individualized to the patient. Higher doses of opioids following surgery were not associated with improved postoperative pain management. Postoperative opioid prescriptions should be tailored to individual patients and procedure types to optimize the dose of opioids prescribed to every patient. Further prospective research is warranted into multimodal pain management strategies targeting better postoperative pain control and decreased opioid use. For any figures or tables, please contact the authors directly.