Intraoperative opioid dosing in children with and without cerebral palsy

Lawrence S. Long, Sudha Ved, Jeffrey L. Koh

Research output: Contribution to journalArticle

17 Scopus citations

Abstract

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 μg·kg -1 fentanyl dose equivalents) than non-CP children (4.58 ± 3.79 μg·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.

Original languageEnglish (US)
Pages (from-to)513-520
Number of pages8
JournalPaediatric Anaesthesia
Volume19
Issue number5
DOIs
StatePublished - May 2009

Keywords

  • Cerebral palsy
  • Children
  • Opioids
  • Orthopedic surgery
  • Pain management

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Anesthesiology and Pain Medicine

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