Black children found to have higher perioperative opioid requirements

New research has found a statistically significant association between race, pain perception, and clinical responses to morphine used to manage perioperative pain. Findings suggest that clinicians should anticipate potentially higher opioid requirements in young black surgical patients and consider increased opioid dosing in response to early signs of inadequate pain control.

The study also found that although white children received less opioids perioperatively, they had higher incidences of opioid-related adverse effects than black children.

The observational study evaluated postoperative pain scores, postoperative opioid requirement, analgesic interventions, and incidences of opioid-related adverse effects in a sample of 194 healthy children aged between 6 and 15 years undergoing elective outpatient tonsillectomy or adenotonsillectomy.

Although previous research suggested there is undertreatment of black patients leading to inadequate pain control, the new study indicates that black children have intrinsically higher morphine requirements for comfort after surgery. Black children had higher postoperative pain scores in the postanesthesia recovery unit after receiving identical morphine doses to white children.

Because postsurgical administration of opioids in patients with obstructive sleep apnea (OSA) has been linked to an increased risk for respiratory complications, the total opioid dose to ensure adequate analgesia is about half in children with OSA. The researchers say that reducing morphine dose is reasonable practice for white patients with OSA but may lead to more pain-related complications postoperatively in black children with OSA.

The researchers conclude that although their study revealed an association between race and postoperative pain perception and responses to perioperative opioids, it was not possible to say whether these differences are related to race per se or to some unknown or immeasurable variables that are also associated with race such as socioeconomic status, pain-coping skills, and unknown genetic factors.

Go back to the current issue of the eConsult.