2024 FSA Podium and Poster Abstracts
P011: THE CONTRIBUTION OF VARIOUS OPIOID ANALGESICS TOWARDS THE INCIDENCE OF PEDIATRIC POSTOPERATIVE VOMITING: A SYSTEMATIC REVIEW AND META-ANALYSIS
Will S Roberts1; Alexander Knight1; Evan Y Maroun1; Brendan P Chernicki1; Thomas M Austin, MD, MS2; F. Cole Dooley, MD2; Christopher M Edwards, MD2; 1Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine; 2University of Florida College of Medicine - Department of Anesthesiology
Introduction/Background: Postoperative vomiting (POV) is the single most common complication of pediatric surgery, with an estimated incidence of nearly 30% depending on the nature of procedure performed. It is widely known that administration of opioid analgesics during the operative course is associated with increased incidence of POV, but the specific extent to which various opioids are implicated has yet to be determined. Identification of differences in POV rates between the analgesic options available to anesthesiologists will further enable customization of the anesthetic plan to each patient, improving outcomes.
Methods: Comprehensive database search yielded 1,725 articles, which were deduplicated to 964 results and screened on standardized inclusion criteria via blind format. Odds ratios for incidence of POV based on exposure to opioids were manually calculated. Random effects meta-analysis generating pooled adjusted odds ratios was performed, with two-sided p-values < 0.05 being considered significant.
Results: Systematic review identified 20 studies that met all criteria for inclusion. A total of 2,518 children were included, of which 272 developed POV, indicating an overall incidence of 10.8%. Further, 19.3% of children who received opioid-inclusive anesthesia vomited, compared to 5.89% of children who received opioid-exclusive anesthesia. Random effects meta-analysis reveals that opioid use (OR 2.86, 1.92 - 4.26, p < 0.01), specifically with fentanyl (OR 3.66, 2.16 - 6.22, p < 0.01) or morphine (OR 4.85, 1.49 - 15.83, p < 0.01), is associated with increased for POV. Tramadol did not meet significance as a risk factor for POV under meta-analysis (OR 1.88, 0.60 - 5.89, p = 0.28).
Discussion/Conclusion: Opioid analgesics are significant contributors to the high incidence of POV seen following pediatric surgery. In cases where children are already predisposed to this complication, care selection of opioid analgesic, sufficient leveraging of regional anesthetic techniques, and prophylactic use of antiemetic medications should prove to reduce this widespread complication and therefore its detrimental sequelae.