title: Race and unequal burden of perioperative pain and opioid related adverse effects in children.
abstract: BACKGROUND
  Interindividual variability in pain perception and analgesic response is a major problem in perioperative practice. Adult studies suggest pain management is influenced by patient's race. The objective of this study is to evaluate the influence of race on perioperative pain treatment in children.
  
  
  METHODS
  Prospective observational study evaluating effect of race on analgesia and opioid related adverse effects after tonsillectomy in African American and Caucasian children. A sample of 194 healthy children between 6 and 15 years of age were included. Race was self-identified by parents. All participants received standard perioperative care with a standard anesthetic and an intraoperative dose of morphine. Analgesia outcomes included maximum postoperative pain scores, postoperative opioid requirement, and analgesic interventions. Safety outcomes included incidences of opioid related adverse effects.
  
  
  RESULTS
  African American children experienced significantly more postoperative pain than Caucasian children as measured by postoperative opioid requirement (P = .0011), maximum postoperative pain scores (P < .0001), and analgesic interventions (P < .0001) in the recovery room. Although Caucasian children received relatively less opioids perioperatively, they had significantly higher opioid related adverse effects (P = .039). African American children with obstructive sleep apnea were more likely to have prolonged post anesthesia recovery unit stay due to inadequate pain control.
  
  
  CONCLUSIONS
  After similar uses of intraoperative morphine for tonsillectomy, there was an unequal burden of increased pain in African American children and increased opioid adverse effects in Caucasian children in the recovery room. Though Caucasian children received relatively less opioids perioperatively, they had higher incidences of opioid related adverse effects than African American children.
authors.affiliation: Division of Human Genetics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio 45229, USA. senthilkumar.sadhasivam@cchmc.org
authors.forename: Senthilkumar
authors.initials: S
authors.lastname: Sadhasivam
authors.forename: Vidya
authors.initials: V
authors.lastname: Chidambaran
authors.forename: Pornswan
authors.initials: P
authors.lastname: Ngamprasertwong
authors.forename: Hope R
authors.initials: HR
authors.lastname: Esslinger
authors.forename: Cynthia
authors.initials: C
authors.lastname: Prows
authors.forename: Xue
authors.initials: X
authors.lastname: Zhang
authors.forename: Lisa J
authors.initials: LJ
authors.lastname: Martin
authors.forename: John
authors.initials: J
authors.lastname: McAuliffe
mesh_terms: D000293:Adolescent; D001741:Black or African American; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005006:Ethnicity; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects*; D059408:Pain Management / Q000379:methods*; D010149:Postoperative Pain / Q000188:drug therapy* / Q000208:ethnology*; D061214:Patient Safety; D020181:Sleep Apnea, Obstructive / Q000208:ethnology* / Q000601:surgery*; D014068:Tonsillectomy; D044465:White People
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine