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More than half of opioids prescribed to pediatric patients after ambulatory knee surgery are unused

Pamela Wendel, MD, Danya DeMeo, BS, Madison R. Heath, BS, Alexandra T. Mackie, BA, PB-BS, Haoyan Zhong, MPA, Kathryn DelPizzo, MD, Kanupriya Kumar, MD, Peter D. Fabricant, MD, MPH


Objective: To determine the number of opioid pills remaining after pediatric ambulatory knee surgery to provide insight into how many pills are actually used.

Design: Prospective observational cohort study. Participants who were expected to be prescribed 20 (Group 1) versus 40 (Group 2) opioid pills according to the institutional policy (based on the type of surgery) were studied. Patient’s reported pain, medication use, and number of opioid pills remaining at postoperative days (PODs) 7 and 14. Participants were not randomly assigned to groups and no intervention was applied.

Setting: An urban tertiary care musculoskeletal institution.

Participants: Sixty adolescents between the ages of 12 and 19 undergoing ambulatory knee surgery.

Interventions: Observational study, no experimental study intervention.

Main outcome measure: The total number of opioid pills remaining.

Results: By POD7, more than 70 percent of patients had stopped taking their prescribed opioid medication mainly because their knee pain was tolerable either without the opioid or by using other medications. By POD14, the mean number of pills taken was 6.3 ± 5.3 for Group 1 and 18.4 ± 13.9 for Group 2. The mean number of unused opioids was 13.5 ± 7.2 for Group 1 and 17.9 ± 13.7 for Group 2.

Conclusions: Even with prescribing practice guidelines in place, opioids may be overprescribed and could be given in a smaller quantity without affecting the quality of acute postoperative pain control in adolescents undergoing ambulatory knee surgery. However, one needs to consider that some patients may need a larger than average amount in order to be appropriately treated for their level of pain and thus prescription amounts—preferably after reevaluation—should be individualized.


adolescent, pediatric ambulatory surgery, pain, prescription, pediatric opioid use

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Wilson N, Kariisa M, Seth P, et al.: Drug and opioid-involved overdose deaths—United States, 2017-2018. MMWR Morb Mortal Wkly Rep. 2020; 69(11): 290-297. DOI: 10.15585/mmwr.mm6911a4.

Rudd RA, Aleshire N, Zibbell JE: Matthew gladden R. Increases in drug and opioid overdose deaths—United States, 2000-2014. Am J Transplant. 2016; 16(4): 1323-1327. DOI: 10.1111/ajt.13776.

Harbaugh CM, Lee JS, Hu HM, et al.: Persistent opioid use among pediatric patients after surgery. Pediatrics. 2018; 141(1): e20172439. DOI: 10.1542/peds.2017-2439.

Fiellin LE, Tetrault JM, Becker WC, et al.: Previous use of alcohol, cigarettes, and marijuana and subsequent abuse of prescription opioids in young adults. J Adolesc Heal. 2013; 52(2): 158-163. DOI: 10.1016/j.jadohealth.2012.06.010.

Denisco RA, Chandler RK, Compton WM: Addressing the intersecting problems of opioid misuse and chronic pain treatment. Exp Clin Psychopharmacol. 2008; 16(5): 417-428. DOI: 10.1037/a0013636.

Rodgers J, Cunningham K, Fitzgerald K, et al.: Opioid consumption following outpatient upper extremity surgery. J Hand Surg Am. 2012; 37(4): 645-650. DOI: 10.1016/j.jhsa.2012.01.035.

Kumar K, Gulotta LV, Dines JS, et al.: Unused opioid pills after outpatient shoulder surgeries given current perioperative prescribing habits. Am J Sports Med. 2017; 45(3): 636-641. DOI: 10.1177/0363546517693665.

Chen Q, Larochelle MR, Weaver DT, et al.: Prevention of prescription opioid misuse and projected overdose deaths in the United States. JAMA Netw Open. 2019; 2(2): e187621. DOI: 10.1001/jamanetworkopen.2018.7621.

Kelley-Quon LI, Kirkpatrick MG, Ricca RL, et al.: Guidelines for opioid prescribing in children and adolescents after surgery: An expert panel opinion. JAMA Surg. 2021; 156: 76. DOI: 10.1001/jamasurg.2020.5045.

Dowell D, Haegerich TM, Chou R: CDC guideline for prescribing opioids for chronic pain—United States, 2016. MMWR Recomm Rep. 2016; 65(1): 1-49. Available at Accessed May 26, 2020.

Garren BR, Lawrence MB, McNaull PP, et al.: Opioid-prescribing patterns, storage, handling, and disposal in postoperative pediatric urology patients. J Pediatr Urol. 2019; DOI: 10.1016/j.jpurol.2019.02.009.

Monitto CL, Hsu A, Gao S, et al.: Opioid prescribing for the treatment of acute pain in children on hospital discharge. Anesth Analg. 2017; 125(6): 2113-2122. DOI: 10.1213/ANE.0000000000002586.

Harris PA, Taylor R, Thielke R, et al.: Research electronic data capture (REDCap)—A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009; 42(2): 377-381. DOI: 10.1016/j.jbi.2008.08.010.

Koehler RM, Okoroafor UC, Cannada LK: A systematic review of opioid use after extremity trauma in orthopedic surgery. Injury. 2018; 49(6): 1003-1007. DOI: 10.1016/j.injury.2018.04.003.

Bedard NA, Sierra RJ, Mabry T, et al.: A commentary excess opioid medication and variation in prescribing patterns following common orthopaedic procedures background: Postoperative pain management in orthopaedic surgery accounts for a substantial portion of opioid. DOI: 10.2106/JBJS.17.00672.

Bockman C, Dale R, Dong J, et al.: Examination of opioid discharge prescriptions, consumption and disposal in an orthopedic population. J Pain. 2017; 18(4): S34. DOI: 10.1016/j.jpain.2017.02.126.

Bicket M, White E, Wu C, et al.: Prescription opioid oversupply following orthopedic surgery: A prospective cohort study. J Pain. 2017; 18(4): S34. DOI: 10.1016/j.jpain.2017.02.124.

Bilgutay AN, Hua H, Edmond M, et al.: Opioid utilization is minimal after outpatient pediatric urologic surgery. J Pediatr Urol. 2020; DOI: 10.1016/j.jpurol.2019.10.021.

O’Donnell FT, Rosen KR: Pediatric pain management: A review. Mo Med. 2014; 111(3): 231-237. Available at Accessed April 21, 2021.

Van Dyke T, Litkowski LJ, Kiersch TA, et al.: Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of postoperative pain: A double-blind, placebo- and active-controlled parallel-group study. Clin Ther. 2004; 26(12): 2003-2014. DOI: 10.1016/j.clinthera.2004.12.002.

Singla N, Pong A, Newman K: Combination oxycodone 5 mg/ibuprofen 400 mg for the treatment of pain after abdominal or pelvic surgery in women: A randomized, double-blind, placebo- and active-controlled parallel-group study. Clin Ther. 2005; 27(1): 45-57. DOI: 10.1016/j.clinthera.2005.01.010.

Miner JR: Randomized double-blind placebo controlled crossover study of acetaminophen, ibuprofen, acetaminophen/hydrocodone, and placebo for the relief of pain from a standard painful stimulus. Acad Emerg Med. 2009; 16(9): 911-914. DOI: 10.1111/j.1553-2712.2009.00496.x.

Marco CA: Comparison of oxycodone and hydrocodone for the treatment of acute pain associated with fractures: A double-blind, randomized, controlled trial. Acad Emerg Med. 2005; 12(4): 282-288. DOI: 10.1197/j.aem.2004.12.005.

Gilron I, Bailey JM, Tu D, et al.: Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005; 352(13): 1324-1334. Available at Accessed May 27, 2020.

Bates C, Laciak R, Southwick A, et al.: Over-prescription of postoperative narcotics: A look at postoperative pain medication delivery, consumption and disposal in urological practice. J Urol. 2011; 185(2): 551-555. DOI: 10.1016/j.juro.2010.09.088.

Silvestre J, Reddy A, De La Cruz M, et al.: Frequency of unsafe storage, use, and disposal practices of opioids among cancer patients presenting to the emergency department. Palliat Support Care. 2017; 15(6): 638-643. DOI: 10.1017/S1478951516000158.

Lewis ET, Cucciare MA, Trafton JA: What do patients do with unused opioid medications? Clin J Pain. 2014; 30(8): 654-662. DOI: 10.1097/01.ajp.0000435447.96642.f4.



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