LEP was not associated with cumulative 24h opioid dose after surgery (0.05 vs 0.06 mEq per kg)

Description #

The total cumulative opioid dose administered within 24 hours (measured as mEq/kg intravenous morphine equivalents) did not differ significantly between LEP and EP children (0.05 vs 0.06 mEq/kg, P = .65) (Table 3). This is a null finding.

"...the total dose of opioid medication (0.05 vs 0.06 mEq/kg, P = .65)..." (Plancarte, 2021, p. 1201)

Methods Context #

What? #ⓘ

The observable: total cumulative opioid dose over the 24-hour postoperative period, expressed as mEq/kg intravenous morphine equivalents.

"total cumulative opioid dosing (defined as mEq/kg intravenous morphine)" (Plancarte, 2021, p. 1200)

How? #ⓘ

Bivariate comparison of the (median) dose between LEP and EP families using Mann-Whitney/appropriate tests on retrospective chart-abstracted data.

"Bivariate association tests comparing the demographic, clinical characteristics, and secondary outcomes between pediatric patients in English proficient and LEP families were performed by using t tests, Mann-Whitney, v2, or Fisher's exact tests as appropriate." (Plancarte, 2021, p. 1201)

Who? #ⓘ

306 children aged 1 to <18 years after single-limb-fracture surgery at one urban tertiary-care children's hospital in New York; 59 (19%) LEP vs 247 EP.

"A total of 337 patients were examined. Of these, 306 met inclusion criteria, of which 59 (19%) were in families with LEP." (Plancarte, 2021, p. 1201)

Other Notes #

Table 3 reports the medians with IQRs: 0.06 (0.04–0.10) mEq/kg EP vs 0.05 (0.04–0.09) mEq/kg LEP (P = .65).

Caveats #

• Opioid and 24-hour null findings may be underpowered given few opioid recipients and wide confidence intervals The opioid-related and 24-hour null findings should not be read as evidence of no effect. Only 66 of 306 patients (22%) received any opioid within 12 hours, and the LEP subgroup is small (n = 59), so these comparisons are likely underpowered. This is reflected in the very wide confidence interval on the unadjusted time-to-first-opioid hazard ratio (0.16–1.40), which spans large effects in both directions. The point estimates for opioids are directionally consistent with the significant analgesia disparity (LEP received opioids less often: 17% vs 23%; HR < 1), so absence of significance may reflect low power rather than true equivalence.