Guidelines for Opioid Use in Pediatric Surgeries

Key Principles for Opioid Use in Pediatric Surgeries

The American Academy of Pediatrics recommends opioid use in pediatric surgeries should prioritize multimodal analgesia with non-opioid medications as first-line treatment, reserving opioids for breakthrough pain and using the lowest effective dose for the shortest duration possible 1, 2
A significant proportion of adolescents with access to opioids misuse them, with many developing dependence or opioid use disorder, according to the American Academy of Pediatrics 2, 3
Prescriptions from healthcare professionals are the most common source of opioids for adolescents who misuse them, as reported by the American Medical Association 1, 2

The American Society of Anesthesiologists recommends NSAIDs should be used as a primary analgesic when not contraindicated, with specific dosing guidelines for ibuprofen, diclofenac, and ketorolac 4, 5, 6
Paracetamol (Acetaminophen) should be used concurrently with NSAIDs, according to the American Academy of Pediatrics, with specific dosing guidelines for oral, IV, and rectal administration 4, 5, 6
Regional anesthesia techniques, such as ultrasound-guided regional blocks, should be utilized whenever possible to reduce opioid requirements, as recommended by the American Society of Regional Anesthesia 7, 8

The American Pain Society recommends fentanyl, morphine, and remifentanil as intraoperative opioids, with specific dosing guidelines 4, 6
For postoperative opioid management, the American Society of Anesthesiologists recommends fentanyl and morphine for PACU breakthrough pain, and tramadol or nalbuphine for ward breakthrough pain, with specific dosing guidelines 4, 6, 8

The American College of Surgeons recommends opioid-free recovery for many minor pediatric procedures, with a combination of NSAIDs and acetaminophen as primary analgesics, and consideration of regional anesthesia techniques when appropriate 1, 9, 5, 7
For moderate procedures, the American Society of Anesthesiologists recommends prioritizing non-opioid medications and regional anesthesia, with opioids only used for breakthrough pain in PACU, and transitioning to oral non-opioid medications as soon as possible 8, 5, 7

The American Academy of Pediatrics recommends developing procedure-specific ERAS (Enhanced Recovery After Surgery) protocols, aiming for oral administration of medications as soon as possible, and providing clear discharge instructions regarding pain management and when to contact healthcare providers 4, 6, 5, 7, 2