title: Early adjuvant use of nonopioids associated with reduced odds of serious postoperative opioid adverse events and need for rescue in children.
abstract: OBJECTIVE
  Examine factors associated with opioid adverse drug events (ADE) in children.
  
  
  OBJECTIVE
  Examine whether adjuvant nonopioid use is associated with a decreased probability of opioid-ADEs and need for rescue.
  
  
  BACKGROUND
  Opioid-ADEs contribute to serious preventable harm for hospitalized children. Adjuvant nonopioid use may mitigate opioid risk postoperatively, yet few studies support this notion.
  
  
  METHODS
  This nested case-control study included children who required intervention or rescue from opioid-ADEs and procedure-matched controls. Data were recorded from medical records and primary outcomes included serious opioid-ADEs (over-sedation and respiratory depression) and need for rescue (e.g., naloxone, rapid response team). Hierarchical logistic regression (HLR) models examined relationships between factors and opioid-ADEs. Early clinical signs and symptoms of deterioration were examined.
  
  
  RESULTS
  Twenty five children with opioid-ADEs and 98 children without events were included. ASA-PS remained an independent risk factor (odds ratio, 2.56 [1.09, 6.03]; P = 0.031), while adjuvant nonopioids a risk reduction factor for opioid-ADEs (OR, 0.16 [0.05, 0.47]; P = 0.001) and need for rescue (0.14 [0.04, 0.47]; P = 0.001). Supplemental oxygen use at PACU discharge was associated with an increased odds of opioid-ADEs (OR, 3.72 [1.35, 10.23]; P = 0.007) and need for rescue (5.5 [1.7, 17.82]; P = 0.002).
  
  
  CONCLUSIONS
  Findings from this study suggest that strategies such as early use of adjuvant nonopioids may reduce risk of opioid-ADEs postoperatively. Furthermore, children who require supplemental oxygen early postoperatively may be at heightened risk of later events.
authors.affiliation: Department of Anesthesiology, University of Michigan Health Systems, Ann Arbor, MI, USA. terriv@umich.edu
authors.forename: Terri
authors.initials: T
authors.lastname: Voepel-Lewis
authors.forename: Deborah
authors.initials: D
authors.lastname: Wagner
authors.forename: Constance
authors.initials: C
authors.lastname: Burke
authors.forename: Alan R
authors.initials: AR
authors.lastname: Tait
authors.forename: Jennifer
authors.initials: J
authors.lastname: Hemberg
authors.forename: Elsa
authors.initials: E
authors.lastname: Pechlivanidis
authors.forename: Shobha
authors.initials: S
authors.lastname: Malviya
authors.forename: Akkeneel
authors.initials: A
authors.lastname: Talsma
mesh_terms: D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000627:therapeutic use*; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D016015:Logistic Models; D008297:Male; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D010149:Postoperative Pain / Q000150:complications / Q000188:drug therapy*; D012307:Risk Factors; D018401:Sample Size; D016896:Treatment Outcome
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D010100:Oxygen