Opioid stewardship is an integral part of delivering high quality surgical care for children. In 2019, the ACS published the Safe and Effective Pain Control After Surgery for Children and Teens brochure, dovetailing work done alongside the American Pediatric Surgical Association (APSA) to develop the first guidelines for postoperative opioid prescribing for children.
The landscape has evolved significantly since those guidelines were developed, with a rapid expansion of research, health policy, and quality improvement efforts to ensure opioid stewardship delivery in everyday surgical practice. Additionally, the American Academy of Pediatrics (AAP) recently published updated guidelines for opioid prescribing for management of acute pain in children and teens.
In response, the ACS updated the handout for families.
Important updates include the following:
- A continued emphasis on maximizing non-opioid analgesia and avoiding opioid monotherapy. A cornerstone of ensuring opioid stewardship is the delivery of non-opioid analgesia when prescribing opioids. Opioids should never be used as monotherapy but instead given alongside non-opioid medications. Families are encouraged to begin with medications such as acetaminophen and ibuprofen for mild to moderate pain before adding prescription opioids for severe pain. The brochure also expanded sections detailing side effects and dosing considerations for both opioid and non-opioid medications per patient and family feedback.
- Increased information on safe prescription opioid disposal. With diversion of unused prescription opioids being a key contributor to nonmedical prescription opioid use in adolescents, safe disposal remains paramount. In addition to providing information on FDA drug take-back programs and recommendations for flushing, the brochure also encourages families to utilize FDA-approved pre-paid mail-back envelopes which are now required by law to be provided by pharmaceutical companies that manufacture opioids.
- Instructions for how to recognize an opioid overdose and deliver naloxone (Narcan). As drug overdose is now the third leading cause of death for US children, the AAP recommends that any healthcare provider prescribing an opioid should co-prescribe naloxone (Narcan), the intranasal overdose reversal medication. Naloxone is an over-the-counter medication that is safe for all age groups. Families must be aware of the signs of an opioid overdose and how to deliver this life-saving medication. Additionally, the brochure now has a section dedicated to instructing families how to recognize the signs of an opioid overdose and deliver naloxone.
The AAP’s updated opioid prescribing guidelines and the new ACS brochure provide a framework for the next generation of opioid stewardship efforts in surgical practice. Surgeons, healthcare providers, and hospitals should create iterative workflows and infrastructure to ensure education on safe prescription opioid use continues to meet the needs of patients and families.
To view the updated content, see Safe and Effective Pain Control After Surgery for Children and Teens | ACS.
The updated content was produced in coordination with the Children’s Surgery Collaborative (CSC), a multi-institutional quality improvement collaborative offered by the ACS to all NSQIP-Pediatric hospitals. Hospitals that choose to participate in the CSC will benefit from enhanced support resources, including collaborative learning sessions, exclusive comparative reports, and contributions towards the CSV Opioid Stewardship and Quality Improvement standards.
For more information, contact childrenssurgery@facs.org.
