Opioid stewardship program implementation in pediatric surgeries: A systematic review

Background: Postoperative opioid use in pediatric surgeries presents significant challenges due to associated risks such as dependence, oversedation, and misuse. Opioid stewardship programs (OSPs) aim to mitigate these risks by promoting appropriate opioid prescribing and multimodal pain strategies. Objectives: To evaluate the effectiveness of current OSPs and their impact on opioid prescribing practices in pediatric surgeries. Methods: We systematically searched PubMed, MEDLINE, Embase, Cochrane Library, CINAHL, and Web of Science for English language studies (2011-2024) that described opioid stewardship initiatives in pediatric surgery. Eighteen studies were included. We included randomized controlled trials, observational studies, and systematic reviews, excluding studies without a formal OSP, studies exclusively focusing on adults, and those without any specific outcomes. Data extraction and quality assessment were performed independently by multiple reviewers. Risk of bias was evaluated using Cochrane and ROBINS-I tools. Results: < 0.001). There were no significant increases in emergency department visits related to reduced opioid prescribing. Pain scores remained stable, and oversedation events were reduced in some settings. Conclusion: Structured opioid stewardship interventions including protocols and guidelines, combined with targeted education and improved pain management techniques, effectively reduce opioid use while preserving adequate pain control. Future multicenter trials and studies will be required to further optimize opioid stewardship interventions and maximize patient outcomes.