Clinical Guideline Review

Guidelines for Opioid Prescribing in Children and Adolescents After Surgery An Expert Panel Opinion

Author(s): Lorraine I. Kelley-Quon, Matthew G. Kirkpatrick, Robert L. Ricca, Robert Baird, Calista M. Harbaugh, Ashley Brady, Paula Garrett, Hale Wills, Jonathan Argo, Karen A. Diefenbach, Marion C.W. Henry, Juan E. Sola, Elaa M. Mahdi, Adam B. Goldin, Shawn D. St Peter, Cynthia D. Downard, Kenneth S. Azarow, Tracy Shields, and, Eugene Kim


Citation: JAMA Surg. 2021;156(1):76-90. doi:10.1001/jamasurg.2020.5045

Method of Review: A subcommittee of the Evidence-Based Practice and Research Committee of the Association of Pediatric Hematology/Oncology Nurses conducted a group review of the clinical recommendations using the AGREE II criteria1. The committee had an overall assessment of approval for endorsement.

Review Summary: These guidelines are the first to be developed for the prescription of opioids during the perioperative periods of pediatric surgery. While basically an expert panel opinion, the panel was multidisciplinary and included nursing and patient advocates. The systematic review of evidence was very well done but the level of evidence is of low quality. The authors acknowledge the limitations which are often due to lack of quality research specific to pediatric patients. Other limitations include the fact that the guidelines offer no recommendations for specific procedures, or specific dosing of pain medications. Specific recommendations do address the need for preparation and education of patients and families. These guidelines are recommended for use because they are unique and address a critical problem. They can be used by health care providers who prescribe opioids to children with cancer or hematology conditions pre or post-surgical procedures assuming this population has a more intense pain experience.

Recommendation for Use: Recommend for use in pediatric hematology and oncology.

1AGREE Next Steps Consortium (2009). The AGREE II Instrument [Electronic version]. Retrieved May 2018, from