Geographic differences in perioperative opioid administration in children

Objectives: To investigate whether geographic differences exist in perioperative opioid administration to children. Aim: To investigate whether perioperative fentanyl use for cleft lip and palate surgery varies between children of three different geographic regions. Background: Differences have been found in perioperative opioid administration to children of differing ethnicity in the USA. Whether similar differences exist in perioperative opioid administration to children residing in different geographic regions is unknown. Methods/Materials: We retrospectively reviewed the medical records of ASA I children who underwent surgery under standardized general anesthesia between January 2010 and April 2011 during SMILE Network International mission trips to Africa, India and Central and South America. Perioperative administration of fentanyl was compared between these three locations. Results: We analyzed data from 79 children who underwent surgery in Africa, 76 in India and 153 in Central and South America. Children in Central and South America were given <50% of the intraoperative amount of fentanyl (2.0 +/- 1.2 mcg.kg-1) administered to children in Africa (4.1 +/- 2.4 mcg.kg-1; P < 0.001) and children in India (4.3 +/- 2.2 mcg.kg-1; P < 0.001). Postoperatively, fentanyl was administered in equivalent doses to all groups. Conclusions: Children in Central and South America received less opioid intraoperatively than African and Indian children, under standardized anesthesia for cleft surgeries. Further research is necessary to elucidate the mechanisms underlying these group differences.