Analgesic Patterns and Opioid Administration in Children Hospitalized with Acute Pancreatitis.

BACKGROUND: Pain is the most common symptom of acute pancreatitis (AP), and opioids have been utilized as the cornerstone of treatment. Despite the adverse effects of opioids, data on effective analgesia in children with AP is lacking. We aimed to evaluate analgesia prescribing patterns in pediatric AP, identify factors associated with opioid administration, and test the associations between opioid administration and hospital length of stay (LOS).

METHODS: This is a retrospective cohort study of pediatric AP hospitalizations in a single institution from 2010 to 2020. Opioid administration was calculated for the first 48 hours of admission (morphine milligram equivalent; MME48). Data on multimodal analgesia (defined as the administration of acetaminophen and nonsteroidal anti-inflammatory drugs) during hospitalization was captured.

RESULTS: The sample included 224 patients, mean age 12.0 years (SD=4.9) and 58.9% female. Median LOS was 4 days (IQR 2-9). Most patients (71.4%) were prescribed opioids, 77.7% acetaminophen, 40.2% NSAIDs and 37.5% multimodal analgesia. Opioid administration decreased over the study period; in contrast, there was an increase in multimodal analgesia administration. Opioid administration did not differ by sex, age, biliary vs non-biliary etiology, or race/ethnicity. In a multivariate regression model, lower albumin values (p<.01) and younger age (p<.05) were significant predictors of increased LOS, while MME48 was not associated with increased LOS.

CONCLUSIONS: Opioids were commonly administered; only 37.5% of children were administered multimodal analgesia during their hospitalization for AP. Opioid administration was not associated with increased LOS. Prospective studies are needed to determine optimal pain management for pediatric AP.