The following is a summary of “Analgesic Patterns and Opioid Administration in Children Hospitalized With Acute Pancreatitis,” published in the June 2023 issue of Pediatrics by Gorbounova, et al.
Acute pancreatitis (AP) is a condition that causes pain, and opioids have traditionally been used as the primary treatment for pain relief. However, there is limited data on effective analgesia in children with AP, and the adverse effects of opioids are a concern. For a study, researchers sought to evaluate the prescribing patterns of analgesia in pediatric AP, identify factors associated with opioid administration, and investigate the associations between opioid use and the length of hospital stay (LOS).
The retrospective cohort study analyzed pediatric hospitalizations for AP at a single institution from 2010 to 2020. Opioid administration during the first 48 hours of admission was calculated in terms of morphine milligram equivalent (MME48). They also collected data on the use of multimodal analgesia, defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs) during hospitalization.
The study included 224 pediatric patients with AP, with a mean age of 12.0 years and 58.9% female. The median length of hospital stay was 4 days, ranging from 2 to 9 days. Most patients (71.4%) were prescribed opioids for pain relief, while 77.7% received acetaminophen, 40.2% received NSAIDs, and only 37.5% received multimodal analgesia. Over the study period, the use of opioids decreased, but the use of multimodal analgesia increased. The administration of opioids did not differ based on sex, age, the cause of AP (biliary vs. non-biliary), or race/ethnicity. In a multivariate regression model, lower albumin values (P < 0.01) and younger age (P < 0.05) were significant predictors of increased hospital LOS, but the MME48 (opioid administration) was not associated with an increased LOS.
The study found that opioids were commonly prescribed for pain relief in children with AP, and only a minority of patients received multimodal analgesia. However, the use of opioids was not associated with a longer hospital stay. Further prospective studies were needed to determine the most effective pain management approach for pediatric AP.