Perioperative methadone for posterior spinal fusion in adolescents: Results from a double-blind randomized-controlled trial.

BACKGROUND: Posterior spinal fusion is the most common surgical procedure performed for correction of adolescent idiopathic scoliosis in the United States. Intraoperative methadone has been shown to improve pain control in adult patients undergoing complex spine surgery, and current pediatric studies show encouraging results; however, prospective randomized-controlled trials are lacking in the pediatric literature. AIMS: We conducted a single-center double-blind randomized-controlled trial to compare intraoperative use of methadone to morphine in pediatric patients undergoing posterior spinal fusion. METHODS: A total of 47 adolescents undergoing posterior spinal fusion were randomized (stratified by sex) to either a methadone (n = 25) or morphine (n = 22) group. The primary outcome was postoperative opioid consumption. Secondary outcomes included postoperative pain severity, opioid-related side effects, and ratio of patient-controlled analgesia injections: attempts as a behavioral index of uncontrolled pain. RESULTS: Patients in the methadone group consumed less total opioid postoperatively (median [interquartile range], 0.3 mg/kg [0.1, 0.5]) than patients in the morphine group (0.3 mg/kg [0.2, 0.6]), median difference [95% confidence interval] -0.07 [-0.2 to 0.02]; (p = .026). Despite the lower amount of opioid used postoperatively, pain scores for the methadone group (3.5 [3.0, 4.3]) were not significantly different from those in the morphine group (4.0 [3.2, 5.0]; p = .250). Groups did not differ on opioid-related side effects. CONCLUSIONS: A two-dose intraoperative methadone regimen resulted in decreased opioid consumption compared to morphine. Although the clinical significance of these results may be limited, the analgesic equipoise without increased opioid-related side effects and potential for a lower incidence of chronic pain may tip the balance in favor of routine methadone use for adolescents undergoing posterior spinal fusion.

Wisconsin's COVID-19 Safer-at-Home Order: Perspectives on Pain, Stress, and Functioning From Pediatric Patients With Chronic Pain.

BACKGROUND: Given that enforced quarantine is associated with psychological distress, our objective was to understand factors that either helped or harmed pediatric chronic pain patients during Wisconsin's 2020 safer-at-home quarantine. METHODS: We reviewed the electronic medical records of 145 pediatric chronic pain patients seen at the Jane B. Pettit Pain and Headache Center, Children's Wisconsin, between April 1 and July 30, 2020. RESULTS: Stress and poor/disturbed lifestyle factors were primary contributors to increased pain. Over half of the sample (58.7%) reported COVID-related stressors as contributing to increased stress levels. Coping, engagement, and socialization were primary contributors to patient functioning. CONCLUSIONS: Continued access to clinicians who can help with coping and stress management techniques is necessary for the well-being of pediatric chronic pain patients during a quarantine.

Use of Aromatherapy for Pediatric Surgical Patients.

BACKGROUND: Children having surgery experience distress from a myriad of sources. Aromatherapy may present an opportunity to promote a healing environment and decrease distress for children following surgery. AIM: Evidence regarding the use of aromatherapy with children is growing. The purpose of this project was to describe our implementation process, subsequent use of and response to aromatherapy for children undergoing surgery. METHODS: This quality improvement project and subsequent retrospective chart review included all patients with documentation of aromatherapy use over an 8-month period. Data collection included demographic data, patient diagnosis, location, information about which oils were used, for which indications, and any outcome the nurse was able to observe (e.g., improved, no change, worsening of symptoms). A nurse-led workgroup developed and implemented a process for aromatherapy in a limited scope when discomfort, nausea/vomiting, nervousness, and sleep disturbances were reported . Charts of all patients with documented aromatherapy use were reviewed for indication/reason for use, oil, and patient response. RESULTS: Results suggest a successful implementation process. Aromatherapy was used by 191 patients (aged 3-22 years). Upset stomach, discomfort, and nervousness were most frequently reported as leading to aromatherapy use. Lavender and peppermint were the most frequently used oils. Of those patients with documented responses, the majority reported improvement. CONCLUSIONS: We were able to successfully implement a new aromatherapy program as an adjunct to care in children undergoing surgery. No adverse events were reported. Documentation is crucial to evaluating any new service.

Pediatric healthcare professionals' perceptions, knowledge, and use of essential oils.

OBJECTIVES: Complementary and Integrative Medicines (CIM) are widely used by adults and children. Despite this, studies have shown that Healthcare Professionals' (HCPs) views about CIM vary. Because underlying knowledge, perceptions and biases may influence HCPs' acceptance of a new aromatherapy program, the investigators sought to assess HCPs' views regarding aromatherapy before implementing an aromatherapy program in a pediatric hospital. DESIGNS AND MEASURES: A convenience sample of HCPs at an academic pediatric hospital in the United States completed an investigator developed online questionnaire about their perceptions, knowledge, and use of essential oils. RESULTS: The sample included 987 respondents, of which: 62.0% were nurses. Overall, 94.2% of HCPs indicated that they "rarely, never, or seldomly" discussed essential oil use with patients. Most indicated a willingness to incorporate essential oils into their patient care with appropriate education. Furthermore, 47.4% of HCPs reported positive views about the use of essential oils, 4.9% reported negative views and opinions, and 45% raised specific concerns about safety, education and/or evidence. CONCLUSION: Overall, this study suggests that HCPs have limited knowledge regarding essential oils, are open to learning more about them, and would like more evidence specifically regarding the efficacy and safety of using essential oils in pediatrics. Additionally, most HCPs are not currently discussing essential oils with pediatric patients. However, they are open to incorporating them into their patients' care if they receive proper education, and are open to our organization implementing an aromatherapy program if appropriate education and safety measures are provided.