Abstract
BACKGROUND: There is a paucity of data depicting post-operative opioid consumption in pediatric solid organ transplant (SOT) recipients, limiting ability to perform power analyses in designing prospective trials focusing on analgesia or adjuvant therapies in these populations. There is additionally unclear effect magnitude of various confounders of analgesic and sedative medications encountered in the pediatric intensive care unit (PICU).
METHODS: Retrospective review of pediatric patients aged 2 months-18 years at a single institution was performed on 137 SOT recipients (cardiac, liver, renal, total pancreatectomy with islet cell autotransplantation [TPIAT]) to evaluate post-operative opioid consumption in the PICU, analgesic confounders, pain scores, and opioid-related adverse effects (constipation, ileus, pruritus, nausea, urinary retention, delirium, respiratory depression, withdrawal). Values for correlative and multiplicative effect magnitude were analyzed for planned variables.
RESULTS: Average daily opioid requirement in oral morphine equivalents per kilogram was (cardiac) 12.5 (median 6.98, interquartile range [IQR] 14.3), (liver) 12.6 (median 10.1, IQR 15.3), (renal) 1.47 (median 0.614, IQR 0.95), and (TPIAT) 4.1 (median 3.44, IQR 2.6). Mechanical ventilation dependence, extracorporeal membrane oxygenation use, and open abdomen or chest demonstrated the highest correlation and effect magnitudes with opioid consumption of variables evaluated. No trends were identified for opioid-related adverse effects.
CONCLUSION: Children receiving SOT have high opioid consumption relative to many populations in the PICU. Control for and evaluation of pain confounders such as mechanical ventilation and extracorporeal membrane oxygenation should be utilized in prospective studies analyzing opioid use, adjuvant analgesics, or outcomes in critically ill transplant recipients.