Cleveland Clinic issues guidelines for pediatric opioid use


Cleveland Clinic’s Center for Pediatric and Adolescent Orthopaedics recently issued guidance on analgesic use in pediatric and adolescent patients.

Currently, there is no nationwide guidance. States conduct regulatory oversight on prescribing opioids for pain management, and the protocols vary.

The center classified procedures into minor, moderate, and major categories.

Minor surgery is defined as needing no incision, just manipulations, and most of these patients do not need opioids. Those who do should not use them for more than three days.

Moderate procedures include more invasive procedures. The center recommends a nonopioid analgesic regimen, and opioids should be used for no more than five days.

Major pediatric orthopaedic surgeries include spine deformities and osteotomies. The center recommends no more than seven days of opioid use.

“Obviously, what we prescribe is going to be different for a patient with simple arthroscopy versus a fracture pinning versus spine surgery,” said center Director Ryan Goodwin, a pediatric orthopaedic surgeon. “These protocols provide a system-based approach to minor, moderate, and major procedures along with a recommended analgesic regimen.”

Well-established protocols are essential, Goodwin said, because they address the general lack of clinical guidance on analgesic use in pediatric patients and the range of care provided within the subspecialty.