INTRODUCTION AND OBJECTIVE:

Healthcare providers are increasingly focused on minimizing opioid usage. Data are limited on factors predicting opioid use in children undergoing outpatient urological surgeries. We aimed to identify factors that can predict the first 24-hour opioid requirements in prepubertal children undergoing outpatient circumcision.

METHODS:

We used prospectively collected data from our previous study on 155 patients comparing two different ultrasound-guided blocks during circumcision. Acetaminophen and Ibuprofen were systematically given in the addition of the regional block. Five doses of morphine were prescribed at home if needed. Validated pain questionnaires, time to the first postoperative dose of narcotics, analgesic consumption during the first 24 hours after surgery and satisfaction were collected.

RESULTS:

Forty-seven boys (30%) did not require any opioids in the hospital or at home. Most patients (63%) did not receive morphine after discharge. Among the 25 patients who took opioids during their hospital stay, 52% sustained necessity for opioid at home during the first 24 hours. A Youden threshold value was found to be significant at 45 minutes post-surgery for patients who used in-house opioids. Of the 25 patients with hospital requirements, 10 patients (40 %) received their first opioids < 45 minutes post-surgery and among them, 2 (20 %) sustained the need during the initial 24 hours (p<0.0147). In contrast, from the 15 patients (60.0 %) who received their first dose of opioids ≥ 45 minutes after surgery, eleven of them (73.3%) subsequently required opioids at home. The cumulative FLACC score ≥ 4 was found to be statistically significant (p=0.0154) for the consumption of narcotics in the first 24 hours.

CONCLUSIONS:

In the first 24-hour postoperative period of pediatric circumcision, non-opioid analgesia on a scheduled basis coupled with a regional block seems to be sufficient for most patients for pain management. Receiving a narcotic dose in the immediate postoperative period seems to influence the subsequent narcotic consumption at home.