Prospective Comparison of Nonnarcotic versus Narcotic Outpatient Oral Analgesic Use after Laparoscopic Appendectomy and Early Discharge

Purpose. To compare narcotic versus nonnarcotic outpatient oral pain management after pediatric laparoscopic appendectomy. Methods. In a prospective study from July 1, 2010, to March 30, 2011, children undergoing laparoscopic appendectomy on a rapid discharge protocol were treated with either nonnarcotic or narcotic postoperative oral analgesia. Two surgeons in a four-person faculty group employed the nonnarcotic regimen, while the other two used narcotics. Days of medication use, time needed for return to normal activity, and satisfaction rate with the pain control method were collected. Student’s t-test was used for statistical analysis. Results. A total of 207 consecutive children underwent appendectomy for acute, nonperforated appendicitis or planned interval appendectomy. The age and time to discharge were equivalent between the nonnarcotic ( ) and narcotic ( ) groups. Both had an equivalent number of medication days and similar times of return to normal activity. Ninety-seven percent of the parents of children in the nonnarcotic group stated that the pain was controlled by the prescribed medication, compared to 90 percent in the narcotic group ( ). Conclusion. This study indicates that after non-complicated pediatric laparoscopic appendectomy, nonnarcotic is equivalent to narcoticbased therapy for outpatient oral analgesia, with higher parental satisfaction. 1. Introduction Previously, pain has been underestimated and undertreated in children, due to individual and social attitudes toward pain and the complexity of its assessment in children [1–3]. Over the past decade, the importance of pain control in the pediatric population has been more widely recognized, especially as outpatient procedures have been performed with increasing frequency; they currently constitute 60% to 70% of operative procedures conducted in North America [4]. Although no population-based data examining practice patterns of postoperative analgesia after ambulatory pediatric general surgical procedures exist, the current standard at many institutions is to provide a prescription for opioids, frequently oral acetaminophen plus codeine or oxycodone for analgesia after outpatient surgery. Nonsteroidal anti-inflammatory drugs (NSAIDs) have been widely studied and are proven to be effective analgesics for postoperative pain control [5, 6]. Unfortunately, no prospective trials have examined the combination of acetaminophen plus NSAIDs compared with acetaminophen plus narcotics in outpatient pediatric surgery procedures. At the community-based children’s hospital where this study