Continued Prescribing of Periprocedural Codeine and Tramadol to Children after a Black Box Warning.

The Journal of Surgical Research
Jonathan E KohlerJessica Schumacher

Abstract

Codeine and tramadol are commonly used analgesics in surgery. In 2013, the Food and Drug Administration (FDA) issued a contraindication to the use of codeine in tonsillectomy and adenoidectomy patients aged below 18 y. This warning was expanded in April 2017 to include tramadol and all children aged below 12 y. We sought to describe the prescribing of codeine and tramadol to contraindicated populations in Wisconsin before and after the release of the expanded FDA warning. Using a statewide Wisconsin claims database, we identified common pediatric ambulatory surgical procedures across the specialties of otolaryngology, urology, general surgery, orthopedics, and ophthalmology. For these procedures, we examined the rates of perioperative codeine and tramadol prescription fills and change in prescribing after the FDA contraindication. Surgeons in all of the specialties studied continued to prescribe codeine to pediatric patients after the contraindication, but tramadol was rarely prescribed. Procedures with relatively high rates of codeine fills were strabismus repair (65% of opioid fills), circumcision >1 yo (22%), and laparoscopic appendectomy (15%). Codeine fills significantly declined after the contraindication to 6% for circum...Continue Reading

References

Dec 31, 2004·The New England Journal of Medicine·Yvan GascheJules Desmeules
Jun 14, 2017·The Laryngoscope·Julie L GoldmanElizabeth M Burckardt
Jul 21, 2017·JAMA Otolaryngology-- Head & Neck Surgery·William C Van Cleve
Mar 21, 2018·Frontiers in Pharmacology·Frédérique RodieuxCaroline F Samer
Dec 5, 2018·Surgery·Randi S CartmillJonathan Emerson Kohler

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Citations

Jun 3, 2021·JAMA Surgery·Lorraine I Kelley-QuonEugene Kim

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