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24 April 2012

Race influences burden of perioperative pain

Children of different races have unequal burdens of perioperative pain and risks of opioid-related adverse effects, according to a report today in Paediatrics.

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Children of different races have unequal burdens of perioperative pain and risks of opioid-related adverse effects, according to a report today in Paediatrics.

"When managing surgical pain in children, clinicians need to anticipate potentially higher opioid requirement in African Americans to avoid inadequate pain control and need to be watchful with morphine related adverse effects in Caucasian children," Dr Senthilkumar Sadhasivam from Cincinnati Children's Hospital Medical Centre in Ohio told Reuters Health by email.

Dr Sadhasivam and colleagues examined the influence of race on postoperative pain perception, opioid requirements, and opioid-related side effects in a prospective study of 194 children ages six to 15 undergoing elective outpatient tonsillectomy or adenotonsillectomy.

Pain higher in Afro- Americans kids

Pain levels were significantly higher among African American children than among Caucasian children, and African American children (especially those with a history of obstructive sleep apnoea) required more analgesic interventions and had a greater postoperative morphine requirement than did Caucasian children.

After adjusting for total morphine administered, overall opioid-related adverse effects were 2.8 times more common in Caucasian patients than in African American patients.

A prolonged stay in the postoperative care unit due to side effects tended to be more common in Caucasian children, but the difference did not reach statistical significance.

Hope to improve perioperative outcomes

"Race of the child is an important factor in perioperative intravenous morphine's clearance and its potential role in personalising analgesia," Dr Sadhasivam said. "Many genetic and non-genetic factors are responsible for observed clinical outcomes."

"Now we have more than 10 major children's hospitals throughout the country participating in a larger multicenter study with children of African-American, Asian, Caucasian, Hispanic, and Native American background to better understand race and gene related outcomes and to individualise perioperative pain management," Dr Sadhasivam said.

"In our research, unlike other genetic association studies, we are studying multiple gene-gene interactions and gene and non-genetic factor interactions in addition to mechanistic aspects to lay foundation for personalised perioperative care in children, who are at higher of having unfavourable outcomes," Dr Sadhasivam added. "In the long term, we hope to improve perioperative outcomes by proactively predicting risk and personalising clinical care."

(Will Boggs MD, Reuters Health, April 2012) 

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