Evaluation of Opioid Administrations After Laparoscopic Appendectomy in Pediatrics With Perforated Versus Non-perforated Appendicitis: A Retrospective Cohort Study.

Objective: Laparoscopic appendectomy is the primary treatment of appendicitis, but multimodal pain regimens are necessary to improve postoperative outcomes and optimize pain control. There are limited data comparing the analgesic requirements between perforated and non-perforated appendicitis and whether perforation requires more opioids due to its complications. The objective of this research is to compare the quantity of opioid administrations in perforated and non-perforated appendicitis following laparoscopic appendectomy to see if there is a difference in analgesic requirements.

Methods: This retrospective, cohort study included pediatric patients that underwent laparoscopic appendectomy for perforated and non-perforated appendicitis. Patients were evaluated from May 4, 2024 through December 31, 2024. The number of administrations of opioids, acetaminophen, and non-steroidal anti-inflammatory drugs were evaluated with binary χ² test and Mann-Whitney U test.

Results: A total of 60 patients were included, with 30 perforated appendicitis and 30 non-perforated appendicitis. Opioids were administered in 50% of perforated and 56.7% of non-perforated appendicitis patients (p = 0.79). A negative binomial regression showed perforated patients administered opioids received 1.58 times the number of opioid administrations on average (p = 0.19) and for each additional year of age, the expected number of opioid administrations increased by 11% (p = 0.05). The median number of non-opioid analgesic administrations were statistically significant in perforated appendicitis patients versus non-perforated, with 2.5 acetaminophen administrations versus 1 (p = 0.002) and 8 NSAID administrations versus 1 (p < 0.001).

Conclusions: The number of opioids administered were similar across groups, but perforated appendicitis patients utilized more acetaminophen.