Intraoperative opioid dosing in children with and without cerebral palsy.
OBJECTIVE
To describe the differences in intraoperative opioid dosing and associated outcomes in children with and without cerebral palsy (CP).


BACKGROUND
Previous work on children with cognitive impairment has suggested that they receive less intraoperative opioid than children without cognitive impairment. This finding may be due to a common concern that impaired children are hypersensitive to the adverse effects of opioids. Patterns in intraoperative opioid dosing have yet to be studied in children with motor impairment (e.g. CP).


METHODS
We examined the medical records of pediatric patients with CP who underwent orthopedic surgery over the last decade at our institution, as well as the records of a randomly selected group of pediatric orthopedic patients without CP (non-CP). Outcome variables were intraoperative opioid dosing, postoperative intensive care unit (ICU) admission, and postoperative oxygen desaturation. We collected demographic, surgical, and medical data for covariate analysis. A stepwise multivariate regression was used for each outcome.


RESULTS
Seventy-one (71) CP and 77 non-CP charts were included in the study. CP children received significantly less intraoperative opioid (3.26 +/- 3.01 microg.kg(-1) fentanyl dose equivalents) than non-CP children (4.58 +/- 3.79 microg.kg(-1)) (P = 0.02), and this difference was corroborated by the regression analysis, which significantly associated CP with decreased opioid dosing (P < 0.001). In addition, intraoperative opioid dosing, but not CP, predicted ICU admission (odds ratio: 1.463, 95% CI: 1.042-2.054, P = 0.03) and postoperative oxygen desaturation (odds ratio: 1.174, 95% CI: 1.031-1.338, P = 0.02).


CONCLUSIONS
Similar to prior research on children with cognitive impairment, a reduction in intraoperative opioid dosing was found in children with CP. Given the discrepant doses of intraoperative opioid between groups, it is unclear whether children with CP are at any greater risk for untoward opioid-related events.
Long
Lawrence S
LS
Georgetown University Medical Center, Building CCC, Room CL-60, 3800 Reservoir Road, NW, Washington, DC 20007, USA. l.stephen.long@gmail.com
Ved
Sudha
S
Koh
Jeffrey L
JL
D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D002547:Cerebral Palsy / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004305:Dose-Response Relationship, Drug; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D007362:Intensive Care Units / Q000706:statistics & numerical data; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D016017:Odds Ratio; D019637:Orthopedic Procedures; D010100:Oxygen / Q000097:blood; D011182:Postoperative Care / Q000379:methods; D011183:Postoperative Complications; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D010100:Oxygen; D005283:Fentanyl