Adolescents’ home pain management after laparoscopic appendectomy: unexpected findings

Appendectomy is the most common surgical reason for emergent pediatric hospitalization. Yet, knowledge of children’s analgesic use after discharge home is limited. As opioid use for the treatment of pain has become more common, prescription opioid diversion has too. Of adolescents who reported misusing prescription opioids, over 40% reported getting them from a friend or relative; and 20% reported getting them from physicians. One fifth of US adolescents self-reported sharing prescription drugs. Prescribers need more information regarding the trajectory of post-surgical pain to provide a sufficient amount of opioid analgesics for pain management without over-prescribing and inadvertently contributing to the problem of controlled substance diversion. The purpose of this investigation is to describe children’s home opioid use after laparoscopic appendectomy. Subjects completed 14 day home pain management diaries; and their prescription opioid analgesics were dispensed with eCap technology. With only 26 children (mean age 13 years 8 months) enrolled, we have identified three types of unexpected findings: 1. Two cases of irregularities in prescription analgesic dispensing– One family reported not filling the prescription, but the prescription monitoring program indicates the drug was dispensed in the child’s name. Another family could not provide state identification; so the drug was not dispensed by the pharmacy for the child’s pain management. 2. Data discrepancies were found in the diaries, eCap data, and pill counts. Based on diary data, 10 of the 12 patients who completed all study procedures had a surplus of pills (mean of 8.5 pills, 4 to 26), but only 8 presented a surplus for pill count (mean of 7.8 pills, 3.5 to 25). 3. There were unexplained pill bottle openings – all on Fridays, Saturdays, or Sundays. These types of unexpected findings suggest barriers to appropriate pain management and provide evidence of the potential for prescription opioid diversion.