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Association Between Race and Ethnicity with Intraoperative Analgesic Administration and Initial Recovery Room Pain Scores in Pediatric Patients: a Single-Center Study of 21,229 Surgeries

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Abstract

Introduction

Perioperative pain may have deleterious effects for all patients. We aim to examine disparities in pain management for children in the perioperative period to understand whether any racial and ethnic groups are at increased risk of poor pain control.

Methods

Medical records from children ≤ 18 years of age who underwent surgery from May 2014 to May 2018 were reviewed. The primary outcome was total intraoperative morphine equivalents. The secondary outcomes were intraoperative non-opioid analgesic administration and first conscious pain score. The exposure was race and ethnicity. The associations of race and ethnicity with outcomes of interest were modeled using linear or logistic regression, adjusted for preselected confounders and covariates. Bonferroni corrections were made for multiple comparisons.

Results

A total of 21,229 anesthetics were included in analyses. In the adjusted analysis, no racial and ethnic group received significantly more or less opioids intraoperatively than non-Hispanic (NH) whites. Asians, Hispanics, and Pacific Islanders were estimated to have significantly lower odds of receiving non-opioid analgesics than NH whites: odds ratio (OR) = 0.83 (95% confidence interval (CI): 0.70, 0.97); OR = 0.84 (95% CI: 0.74, 0.97), and OR = 0.53 (95% CI: 0.33, 0.84) respectively. Asians were estimated to have significantly lower odds of reporting moderate-to-severe pain on awakening than NH whites: OR = 0.80 (95% CI: 0.66, 0.99).

Conclusions

Although children of all races and ethnicities investigated received similar total intraoperative opioid doses, some were less likely to receive non-opioid analgesics intraoperatively. Asians were less likely to report moderate-severe pain upon awakening. Further investigation may delineate how these differences lead to disparate patient outcomes and are influenced by patient, provider, and system factors.

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Abbreviations

LPCH:

Lucile Packard Children’s Hospital Stanford

EMR:

Electronic medical record

OR:

Operating room

ASA:

American Society of Anesthesiologists physical status classification

FLACC:

Face, Legs, Activity, Cry, Consolability pain scale

PACU:

Post-anesthesia care unit

OSA:

Obstructive sleep apnea

ICD:

International Classification of Diseases

LTR:

Likelihood ratio test

OR:

Odds ratio

CI:

Confidence interval

ICU:

Intensive care unit

IQR:

Interquartile range

SD:

Standard deviation

NH whites:

Non-Hispanic whites

References

  1. Berdahl TA, Friedman BS, McCormick MC, Simpson L. Annual report on health care for children and youth in the United States: trends in racial/ethnic, income, and insurance disparities over time, 2002-2009. Acad Pediatr. 2013;13(3):191–203.

    Article  PubMed  Google Scholar 

  2. Betancourt JR, Green AR, Carrillo JE, Ananeh-Firempong O II. Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care. Public Health Rep. 2003;118(4):293–302.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Flores G, R. Committee On Pediatric. Technical report--racial and ethnic disparities in the health and health care of children. Pediatrics. 2010;125(4):e979–e1020.

    Article  PubMed  Google Scholar 

  4. Lange EMS, Rao S, Toledo P. Racial and ethnic disparities in obstetric anesthesia. Semin Perinatol. 2017;41(5):293–8.

    Article  PubMed  Google Scholar 

  5. Peterson K, Anderson J, Boundy E, Ferguson L, McCleery E, Waldrip K. Mortality disparities in racial/ethnic minority groups in the Veterans Health Administration: an evidence review and map. Am J Public Health. 2018;108(3):e1–e11.

    Article  PubMed  PubMed Central  Google Scholar 

  6. van Gulik L, Ahlers SJGM, van de Garde EMW, Bruins P, van Boven WJ, Tibboel D, et al. Remifentanil during cardiac surgery is associated with chronic thoracic pain 1 yr after sternotomy. Br J Anaesth. 2012;109(4):616–22.

    Article  PubMed  CAS  Google Scholar 

  7. Fletcher D, Martinez V. Opioid-induced hyperalgesia in patients after surgery: a systematic review and a meta-analysis. Br J Anaesth. 2014;112(6):991–1004.

    Article  CAS  PubMed  Google Scholar 

  8. Lee LA, Caplan RA, Stephens LS, Posner KL, Terman GW, Voepel-Lewis T, et al. Postoperative opioid-induced respiratory depression: a closed claims analysis. Anesthesiology. 2015;122(3):659–65.

    Article  CAS  PubMed  Google Scholar 

  9. Long DR, Lihn AL, Friedrich S, Scheffenbichler FT, Safavi KC, Burns SM, et al. Association between intraoperative opioid administration and 30-day readmission: a pre-specified analysis of registry data from a healthcare network in New England. Br J Anaesth. 2018;120(5):1090–102.

    Article  CAS  PubMed  Google Scholar 

  10. von Dincklage F, Jakuscheit A, Weth J, Lichtner G, Jurth C, Rehberg-Klug B. Higher doses of intraoperative analgesia are associated with lower levels of persistent pain and less analgesic consumption six months after total hip arthroplasty. Eur J Pain. 2018;22(4):691–9.

    Article  CAS  Google Scholar 

  11. Joshi GP, Ogunnaike BO. Consequences of inadequate postoperative pain relief and chronic persistent postoperative pain. Anesthesiol Clin North Am. 2005;23(1):21–36.

    Article  PubMed  Google Scholar 

  12. Baratta JL, Schwenk ES, Viscusi ER. Clinical consequences of inadequate pain relief: barriers to optimal pain management. Plast Reconstr Surg. 2014;134(4 Suppl 2):15S–21S.

    Article  CAS  PubMed  Google Scholar 

  13. Pavlin DJ, Chen C, Penaloza DA, Buckley FP. A survey of pain and other symptoms that affect the recovery process after discharge from an ambulatory surgery unit. J Clin Anesth. 2004;16(3):200–6.

    Article  PubMed  Google Scholar 

  14. Fortier J, Chung F, Su J. Unanticipated admission after ambulatory surgery--a prospective study. Can J Anaesth. 1998;45(7):612–9.

    Article  CAS  PubMed  Google Scholar 

  15. Pavlin DJ, et al. Pain as a factor complicating recovery and discharge after ambulatory surgery. Anesth Analg. 2002;95(3):627–34 table of contents.

    Article  PubMed  Google Scholar 

  16. Pavlin DJ, et al. Factors affecting discharge time in adult outpatients. Anesth Analg. 1998;87(4):816–26.

    Article  CAS  PubMed  Google Scholar 

  17. Jimenez N, et al. Perioperative analgesic treatment in Latino and non-Latino pediatric patients. J Health Care Poor Underserved. 2010;21(1):229–36.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Nafiu OO, Chimbira WT, Stewart M, Gibbons K, Porter LK, Reynolds PI. Racial differences in the pain management of children recovering from anesthesia. Paediatr Anaesth. 2017;27(7):760–7.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Rosenbloom JM, Senthil K, Long AS, Robinson WR, Peeples KN, Fiadjoe JE, et al. A limited evaluation of the association of race and anesthetic medication administration: a single-center experience with appendectomies. Paediatr Anaesth. 2017;27(11):1142–7.

    Article  PubMed  Google Scholar 

  20. Jimenez N, Anderson GD, Shen DD, Nielsen SS, Farin FM, Seidel K, et al. Is ethnicity associated with morphine’s side effects in children? Morphine pharmacokinetics, analgesic response, and side effects in children having tonsillectomy. Paediatr Anaesth. 2012;22(7):669–75.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Committee, S.S., NQF-Endorsed measures for surgical procedures, 2015-2017, H.a.H. Services, Editor. 2017, National Quality Forum: 1030 15th St NW, Suite 800 Washington, DC 20005.

  22. Hall, M.J., et al., Ambulatory surgery data from hospitals and ambulatory surgery centers: United States, 2010. Natl Health Stat Report, 2017(102): p. 1–15.

  23. National Center for Health Statistics (U.S.), National hospital discharge survey: 2010 table, procedures by selected patient characteristics - number by procedure category and age, in DHHS publication. 2010, U.S. Dept. of Health and Human Services, Centers for Disease Control and Prevention: Hyattsville, Md. p. v.

  24. Section on, A. and M. Pain. The pediatrician’s role in the evaluation and preparation of pediatric patients undergoing anesthesia. Pediatrics. 2014;134(3):634–41.

    Article  Google Scholar 

  25. Jimenez N, Jackson DL, Zhou C, Ayala NC, Ebel BE. Postoperative pain management in children, parental English proficiency, and access to interpretation. Hosp Pediatr. 2014;4(1):23–30.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Berry JG, et al. Pediatrics. 2019:143(4).

  27. Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006;118(2):651–8.

    Article  PubMed  Google Scholar 

  28. Rony RY, et al. Parental postoperative pain management: attitudes, assessment, and management. Pediatrics. 2010;125(6):e1372–8.

    Article  PubMed  Google Scholar 

  29. Rosenberg RE, Clark RA, Chibbaro P, Hambrick HR, Bruzzese JM, Feudtner C, et al. Factors predicting parent anxiety around infant and toddler postoperative and pain. Hosp Pediatr. 2017;7(6):313–9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Schwenk ES, Mariano ER. Designing the ideal perioperative pain management plan starts with multimodal analgesia. Korean J Anesthesiol. 2018;71(5):345–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  31. Butwick AJ, Blumenfeld YJ, Brookfield KF, Nelson LM, Weiniger CF. Racial and ethnic disparities in mode of anesthesia for cesarean delivery. Anesth Analg. 2016;122(2):472–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Glance LG, Wissler R, Glantz C, Osler TM, Mukamel DB, Dick AW. Racial differences in the use of epidural analgesia for labor. Anesthesiology. 2007;106(1):19–25 discussion 6-8.

    Article  PubMed  Google Scholar 

  33. King MR, de Souza E, Rosenbloom JM, Wang E, Anderson TA. Association between race and ethnicity in the delivery of regional anesthesia for pediatric patients: a single-center study of 3189 regional anesthetics in 25,664 surgeries. Anesth Analg. 2020;131(1):255–62.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Memtsoudis SG, Besculides MC, Swamidoss CP. Do race, gender, and source of payment impact on anesthetic technique for inguinal hernia repair? J Clin Anesth. 2006;18(5):328–33.

    Article  PubMed  Google Scholar 

  35. Memtsoudis SG, Poeran J, Zubizarreta N, Rasul R, Opperer M, Mazumdar M. Anesthetic care for orthopedic patients: is there a potential for differences in care? Anesthesiology. 2016;124(3):608–23.

    Article  CAS  PubMed  Google Scholar 

  36. Disparities in health care quality among racial and ethnic minority groups: selected findings from the 2010 national healthcare quality and disparities reports, A.f.H.R.a. Quality, Editor. 2011: Rockville, MD p 4.

  37. Pinheiro PS, Callahan KE, Boscoe FP, Balise RR, Cobb TR, Lee DJ, et al. Cancer site-specific disparities in New York, including the 1945-1965 birth cohort’s impact on liver cancer patterns. Cancer Epidemiol Biomark Prev. 2018;27(8):917–27.

    Article  Google Scholar 

  38. Ahonen J, Olkkola KT, Hynynen M, Seppälä T, Ikävalko H, Remmerie B, et al. Comparison of alfentanil, fentanyl and sufentanil for total intravenous anaesthesia with propofol in patients undergoing coronary artery bypass surgery. Br J Anaesth. 2000;85(4):533–40.

    Article  CAS  PubMed  Google Scholar 

  39. Zhu A, Benzon HA, Anderson TA. Evidence for the efficacy of systemic opioid-sparing analgesics in pediatric surgical populations: a systematic review. Anesth Analg. 2017;125(5):1569–87.

    Article  CAS  PubMed  Google Scholar 

  40. Aldrete JA, Kroulik D. A postanesthetic recovery score. Anesth Analg. 1970;49(6):924–34.

    Article  CAS  PubMed  Google Scholar 

  41. Boonstra AM, et al. Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: variability and influence of sex and catastrophizing. Front Psychol. 2016;7:1466.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Gerbershagen HJ, Rothaug J, Kalkman CJ, Meissner W. Determination of moderate-to-severe postoperative pain on the numeric rating scale: a cut-off point analysis applying four different methods. Br J Anaesth. 2011;107(4):619–26.

    Article  CAS  PubMed  Google Scholar 

  43. Hirschfeld G, Zernikow B. Variability of “optimal” cut points for mild, moderate, and severe pain: neglected problems when comparing groups. Pain. 2013;154(1):154–9.

    Article  PubMed  Google Scholar 

  44. Schoenfeld AJ, Nwosu K, Jiang W, Yau AL, Chaudhary MA, Scully RE, et al. Risk factors for prolonged opioid use following spine surgery, and the association with surgical intensity, among opioid-naive patients. J Bone Joint Surg Am. 2017;99(15):1247–52.

    Article  PubMed  Google Scholar 

  45. Cron DC, Englesbe MJ, Bolton CJ, Joseph MT, Carrier KL, Moser SE, et al. Preoperative opioid use is independently associated with increased costs and worse outcomes after major abdominal surgery. Ann Surg. 2017;265(4):695–701.

    Article  PubMed  Google Scholar 

  46. Flegal KM, Cole TJ. Construction of LMS parameters for the Centers for Disease Control and Prevention 2000 growth charts. Natl Health Stat Report. 2013(63):1–3.

  47. Statistics, N.C.f.H CDC growth charts: percentile data files with LMS values. 2000 08/04/2009 [cited 2019 07/20/2019]; Available from: https://www.cdc.gov/growthcharts/percentile_data_files.htm.

  48. Unequal treatment: confronting racial and ethnic disparities in health care, B.D. Smedley, A.Y. Stith, and A.R. Nelson, Editors. 2003: Washington (DC).

  49. Kim EJ, Kim T, Paasche-Orlow MK, Rose AJ, Hanchate AD. Disparities in hypertension associated with limited English proficiency. J Gen Intern Med. 2017;32(6):632–9.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Pain, T.F.o.T.o.t.I.A.f.t.S.o., Classification of chronic pain: descriptions of chronic pain sydromes and definitions of pain terms. 2nd ed, ed. H. Merskey and N. Bogduk. 1994, Seattle, WA 98105: International Association for the Study of Pain. 238.

  51. Faul F, Erdfelder E, Buchner A, Lang AG. Statistical power analyses using G*Power 3.1: tests for correlation and regression analyses. Behav Res Methods. 2009;41(4):1149–60.

    Article  PubMed  Google Scholar 

  52. Liu W, Liu J, Tan X, Wang S. Ultrasound-guided lower forearm median nerve block in open surgery for trigger thumb in 1- to 3-year-old children: a randomized trial. Paediatr Anaesth. 2018;28(2):134–41.

    Article  PubMed  Google Scholar 

  53. Luo M, Liu X, Ning L, Sun Y, Cai Y, Shen S’. Comparison of ultrasonography-guided bilateral intercostal nerve blocks and conventional patient-controlled intravenous analgesia for pain control after the Nuss procedure in children: a prospective randomized study. Clin J Pain. 2017;33(7):604–10.

    Article  PubMed  Google Scholar 

  54. Friedrichsdorf SJ, Postier A, Eull D, Weidner C, Foster L, Gilbert M, et al. Pain outcomes in a US Children’s hospital: a prospective cross-sectional survey. Hosp Pediatr. 2015;5(1):18–26.

    Article  PubMed  Google Scholar 

  55. Harrison D, Joly C, Chretien C, Cochrane S, Ellis J, Lamontagne C, et al. Pain prevalence in a pediatric hospital: raising awareness during Pain Awareness Week. Pain Res Manag. 2014;19(1):e24–30.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Taylor EM, Boyer K, Campbell FA. Pain in hospitalized children: a prospective cross-sectional survey of pain prevalence, intensity, assessment and management in a Canadian pediatric teaching hospital. Pain Res Manag. 2008;13(1):25–32.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Walther-Larsen S, Pedersen MT, Friis SM, Aagaard GB, Rømsing J, Jeppesen EM, et al. Pain prevalence in hospitalized children: a prospective cross-sectional survey in four Danish university hospitals. Acta Anaesthesiol Scand. 2017;61(3):328–37.

    Article  CAS  PubMed  Google Scholar 

  58. Segerdahl M, et al. Children in day surgery: clinical practice and routines. The results from a nation-wide survey. Acta Anaesthesiol Scand. 2008;52(6):821–8.

    Article  CAS  PubMed  Google Scholar 

  59. Dixon S, et al. Behavioral effects of circumcision with and without anesthesia. J Dev Behav Pediatr. 1984;5(5):246–50.

    Article  CAS  PubMed  Google Scholar 

  60. Gan TJ. Poorly controlled postoperative pain: prevalence, consequences, and prevention. J Pain Res. 2017;10:2287–98.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  61. Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859–71.

    Article  PubMed  Google Scholar 

  62. Weisman SJ, Bernstein B, Schechter NL. Consequences of inadequate analgesia during painful procedures in children. Arch Pediatr Adolesc Med. 1998;152(2):147–9.

    Article  CAS  PubMed  Google Scholar 

  63. Michelet D, Andreu-Gallien J, Bensalah T, Hilly J, Wood C, Nivoche Y, et al. A meta-analysis of the use of nonsteroidal antiinflammatory drugs for pediatric postoperative pain. Anesth Analg. 2012;114(2):393–406.

    Article  CAS  PubMed  Google Scholar 

  64. Afman CE, Welge JA, Steward DL. Steroids for post-tonsillectomy pain reduction: meta-analysis of randomized controlled trials. Otolaryngol Head Neck Surg. 2006;134(2):181–6.

    Article  PubMed  Google Scholar 

  65. Cho HK, Kim KW, Jeong YM, Lee HS, Lee YJ, Hwang SH. Efficacy of ketamine in improving pain after tonsillectomy in children: meta-analysis. PLoS One. 2014;9(6):e101259.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  66. Dahmani S, Michelet D, Abback PS, Wood C, Brasher C, Nivoche Y, et al. Ketamine for perioperative pain management in children: a meta-analysis of published studies. Paediatr Anaesth. 2011;21(6):636–52.

    Article  PubMed  Google Scholar 

  67. Lambert P, et al. Clonidine premedication for postoperative analgesia in children. Cochrane Database Syst Rev. 2014;1:CD009633.

    Google Scholar 

  68. Bellon M, le Bot A, Michelet D, Hilly J, Maesani M, Brasher C, et al. Efficacy of intraoperative dexmedetomidine compared with placebo for postoperative pain management: a meta-analysis of published studies. Pain Ther. 2016;5(1):63–80.

    Article  PubMed  PubMed Central  Google Scholar 

  69. Schnabel A, Reichl SU, Poepping DM, Kranke P, Pogatzki-Zahn EM, Zahn PK. Efficacy and safety of intraoperative dexmedetomidine for acute postoperative pain in children: a meta-analysis of randomized controlled trials. Paediatr Anaesth. 2013;23(2):170–9.

    Article  PubMed  Google Scholar 

  70. Russell P, von Ungern-Sternberg BS, Schug SA. Perioperative analgesia in pediatric surgery. Curr Opin Anaesthesiol. 2013;26(4):420–7.

    Article  CAS  PubMed  Google Scholar 

  71. Singhal NR, Jones J, Semenova J, Williamson A, McCollum K, Tong D, et al. Multimodal anesthesia with the addition of methadone is superior to epidural analgesia: a retrospective comparison of intraoperative anesthetic techniques and pain management for 124 pediatric patients undergoing the Nuss procedure. J Pediatr Surg. 2016;51(4):612–6.

    Article  PubMed  Google Scholar 

  72. Kehlet H, Jensen TS, Woolf CJ. Persistent postsurgical pain: risk factors and prevention. Lancet. 2006;367(9522):1618–25.

    Article  PubMed  Google Scholar 

  73. Rove KO, Edney JC, Brockel MA. Enhanced recovery after surgery in children: promising, evidence-based multidisciplinary care. Paediatr Anaesth. 2018;28(6):482–92.

    Article  PubMed  Google Scholar 

  74. Shinnick JK, Short HL, Heiss KF, Santore MT, Blakely ML, Raval MV. Enhancing recovery in pediatric surgery: a review of the literature. J Surg Res. 2016;202(1):165–76.

    Article  PubMed  Google Scholar 

  75. Aviram J, Samuelly-Leichtag G. Efficacy of cannabis-based medicines for pain management: a systematic review and meta-analysis of randomized controlled trials. Pain Physician. 2017;20(6):E755–96.

    Article  CAS  PubMed  Google Scholar 

  76. Kim HJ, Yang GS, Greenspan JD, Downton KD, Griffith KA, Renn CL, et al. Racial and ethnic differences in experimental pain sensitivity: systematic review and meta-analysis. Pain. 2017;158(2):194–211.

    Article  PubMed  Google Scholar 

  77. Rahim-Williams B, Riley JL III, Williams AKK, Fillingim RB. A quantitative review of ethnic group differences in experimental pain response: do biology, psychology, and culture matter? Pain Med. 2012;13(4):522–40.

    Article  PubMed  Google Scholar 

  78. Lu Q, Zeltzer L, Tsao J. Multiethnic differences in responses to laboratory pain stimuli among children. Health Psychol. 2013;32(8):905–14.

    Article  PubMed  PubMed Central  Google Scholar 

  79. Estimated population ages 0–17, by race/ethnicity (e.g., an estimated 419,938 multiracial children lived in California in 2018). C.D.o. Finance, Editor. 2018, U.S. Census Bureau.

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Funding

Dr. Rosenbloom’s work was supported by the National Institutes of Health T32 GM007592 grant (Research Training for Anesthetists). All other support was provided from institutional and/or departmental sources.

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Authors and Affiliations

  1. Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, 300 Pasteur Drive, Stanford, CA, USA

    Christine G. Jette, Ellen Wang, Elizabeth De Souza & T. Anthony Anderson

  2. Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    Julia M. Rosenbloom

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  1. Christine G. Jette
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Contributions

Christine G. Jette: This author helped with research conceptualization and design, data analysis, data interpretation, writing, and final approval of the manuscript.

Julia M. Rosenbloom: This author helped with research conceptualization and design, writing and final approval of the manuscript.

Ellen Wang: This author helped with research conceptualization and design, patient recruitment, data collection, data interpretation, writing, and final approval of the manuscript.

Elizabeth De Souza: This author helped with research conceptualization and design, data analysis, data interpretation, writing, and final approval of the manuscript.

T. Anthony Anderson: This author helped with research conceptualization and design, patient recruitment, data collection, data interpretation, writing, and final approval of the manuscript.

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Correspondence to T. Anthony Anderson.

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Jette, C.G., Rosenbloom, J.M., Wang, E. et al. Association Between Race and Ethnicity with Intraoperative Analgesic Administration and Initial Recovery Room Pain Scores in Pediatric Patients: a Single-Center Study of 21,229 Surgeries. J. Racial and Ethnic Health Disparities 8, 547–558 (2021). https://doi.org/10.1007/s40615-020-00811-w

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