Opioid analgesia to prevent paediatric post-traumatic stress after injury: a scoping review

Traumatic injuries affect thousands of children every year. Often frightening and painful, such events can be the catalyst for chronic post-traumatic stress symptoms (PTSSs) that include hyperarousal, reexperiencing, affective and behavioral sequelae. Evidence from adult and paediatric populations suggests that opioid analgesia, a mainstay of emergency care after traumatic injury, may reduce the risk of PTSS among injured patients. The aim of this scoping review was to examine the literature addressing the relationship between opioids and PTSS among injured children by reviewing and map the existing literature to inform recommendations for future research. Two systematic database searches were undertaken, identifying 919 records, from which six primary studies were included for review. Five articles reported that opioids reduced the risk of PTSS, whereas the remaining articles did not report the direct opioid-PTSS relationship. Results of this review indicate that the conclusion made by researchers that opioids offer protection against PTSS is premature. Future research should focus on opioids administered in the 48 hours after injury. Symptoms should be measured soon after injury and repeated. Models of risk of PTSS should control for known risk factors. Research that enhances understanding of PTSS risk has the potential to improve outcomes for the thousands of children who develop psychopathology following injury every year.