Lab Description
The Pediatric Pain and Analgesic Trials Laboratory recognizes that the perioperative management of pain in children and adolescents is associated with numerous age- and surgery-specific complexities, and that a substantial proportion of pediatric patients suffer from poor postoperative pain recovery. Compared to adult populations, pediatric pain conditions remain underrecognized and undertreated, which can, in some cases, lead to life-long comorbidities. Rigorous scientific approaches, particularly well-designed and pragmatic clinical trials, are needed to optimize analgesic management and fill the formidable knowledge gaps in this field.
The lab focuses on key areas of pediatric pain research, including perioperative pain management, age-specific opioid pharmacology and safety, the role of regional anesthesia in children, and the individual differences that influence chronic pain development after surgery. It aims to address critical clinical questions in pediatric pain management by conducting practice-changing research to improve the care of children undergoing surgery. Through interventional and observational clinical trials, as well as mechanistic analgesic studies, we strive to advance the safe and effective use of both existing and novel analgesic approaches for children and adolescents.
Research Projects
OPTIMAL: Optimization of Pediatric Tonsillectomy to IMprove AnaLgesia
Project synopsis: The objective of this randomized controlled trial is to identify the optimal age-specific weight-based dose of methadone to provide safe, effective, and improved analgesia after pediatric tonsillectomy.
Funding: NIH / NICHD
ClinicalTrials.gov ID: NCT06576830
PRACS: Pediatric Regional Anesthesia for Cardiac Surgery
Project synopsis: The objective of this randomized controlled trial is to evaluate the effect of regional anesthesia on opioid use and analgesic outcomes after pediatric cardiac surgery.
Funding: Society of Pediatric Anesthesia
ClinicalTrials.gov ID: NCT05688670
Peds CPSP: Characterizing Neurobiological Effects of Chronic Postsurgical Pain (CPSP) in Children and Adolescents
Project synopsis: The objective of this observational study is to investigate the clinical and mechanistic factors in the development of chronic postsurgical pain following major surgery in adolescents using functional MRI, sensory testing, and patient-reported outcomes.
Funding: Duke Anesthesiology
EPIC-3P: A Multicenter Study of Genomic and Psychological Factors Affecting Postoperative and Chronic Pain in Children Undergoing Invasive (Spine) Surgery
Project synopsis: The objective of this observational study assesses the impact of genomic and psychological factors resulting in the development of chronic post-surgical pain (CPSP) following pediatric spine surgery.
Funding: NIH / NIAMS
ClinicalTrials.gov ID: NCT02998138
Periop-ASD: The Impact of Adaptive Sensory Environments on the Perioperative Care for Children with ASD
Project synopsis: The objective of this study is to evaluate innovative interventions that prioritize the use of adaptive sensory environments (ASE) and individualized behavioral coping plans (BCP) to advance the everyday anesthetic and surgical care provided to children with autism spectrum disorders.
Funding: Organization for Autism Research
STS-RA: U.S. Practice Patterns for the use of Regional Anesthesia for Pediatric Cardiac Surgery and Impact on Perioperative Outcomes
Project synopsis: The object of this study is to analyze the Society of Thoracic Surgery Congenital Heart Surgery Database to characterize regional anesthesia practice patterns and associated perioperative outcomes in congenital heart surgery in the United States.
Lab Members
In the News
That’s a Wrap! Highlights from ASA 2024
Revolutionizing Pediatric Tonsillectomy Therapeutics
Congratulations to the 2022 LEADER Alumni!
External News
Multi-Institutional Study of Multimodal Analgesia Practice, Pain Trajectories, and Recovery Trends After Spine Fusion for Idiopathic Scoliosis
January 02, 2025
Society for Pediatric Pain Medicine
Press Release: OAR Shares 2024 Applied Research Grant Winners
December 05, 2024
Organization for Autism Research
Featured Author Podcast: Single-dose Methadone for Pediatric Tonsillectomy
August 27, 2024
Anesthesiology Journal's Podcast
Selected Publications
- Einhorn LM, Monitto C, Ganesh A, Duan Q, Ramamurthi RJ, Barnett K, Ding L, Chidambaran V. Multi-institutional study of multimodal analgesia practice, pain trajectories, and recovery trends following spine fusion for idiopathic scoliosis. Anesthesia and Analgesia, DOI: 10.1213/ANE.0000000000007351. PMID: 39745877
- Fiorillo BP, Melton MS, Nelsen D, Einhorn LM. Admixture of Liposomal Bupivacaine and Bupivacaine Hydrochloride for Peripheral Nerve Blocks in Adolescents Undergoing Orthopedic Surgery: An Observational Cohort Study. Journal of Clinical Medicine. 2024 Dec 13;13(24):7586. PMID: 39768510
- Andrew BY, Pfaff K, Jooste S, Einhorn LM. Factors associated with the Use of Regional Anesthesia for Calcaneal Osteotomy in Pediatric Patients. Pediatric Anesthesia. 2025 Feb;35(2):107-117. PMID: 39520183.
- Upton BA, Krolic, KN, Zhang X, Pilipenko V, Martin L, Ji H, Glynn S, Barnett K, Ganesh A, Monitto CL, Einhorn LM, Ramamurthi RJ, Chidambaran V. Multi-center study of OPRM1 A118G and promoter-region DNA methylation associations with opioid outcomes and chronic post-surgical pain after pediatric musculoskeletal surgery – secondary analyses. Pain Reports. 9(6):p e1201, December 2024. DOI: 10.1097/PR9.0000000000001201
- Jones K, Hatlevig C, Thompson J, Einhorn LM, Rowe W, Funk E. Impact of a Tranexamic Acid Dosing Practice Guideline in Reducing Blood Product Administration in Pediatric Scoliosis Surgery. AANA J. 2024 Oct 1;92(5):363-371. PMID: 39361483
- Moreno Duarte I, Brandsen S, Dawson G, Einhorn LM, Swaminathan M. Integrating tailored approaches in perioperative care strategies for neurodivergent individuals. Lancet eClinicalMedicine. 2024;76:102846. PMID: 39398495
- Einhorn LM, Krishnan P, Poirier C, Ingelmo P. Chronic Postsurgical Pain in Children: A call for action. Journal of Pain Research. 2024;17:1967-1978. PMID: 38828088.
- Einhorn LM, Hoang J, La J, Kharasch ED. Single-Dose Intraoperative Methadone for Pain Management in Pediatric Tonsillectomy: A Randomized Double Blind Clinical Trial. Anesthesiology. 2024 Sep 1;141(3):463-474. PMID: 38669011.
- Sadacharam K, Furstein JS, Staffa S, Li, G, Karroum R, Booth JM, Kim E, McCahan SM, Muhly TM, Chidambaran V, SPAIN-ACL Investigators: Einhorn LM. Multisite Prospective Study of Perioperative Pain Management Practices for Anterior Cruciate Ligament Reconstruction in Adolescents – Society for Pediatric Anesthesia Improvement Network (SPAIN) Project Report. Regional Anesthesia and Pain Medicine. 2024 Apr 18:rapm-2024-105381. PMID: 38637132.
- Einhorn LM, Hudon J, Ingelmo P. Pharmacological Treatment of Neuropathic Pain in Children. Current Neuropharmacology. 2024;22(1):38-52. PMID: 37539933.
- Breglio AM, Fitzgerald TN, Moore CB, Einhorn LM. Evaluation of Analgesic Practice Changes Following the Nuss Procedure in Pediatric Patients. Journal of Surgical Research. 2023 Nov;291: 286-295. PMID: 37481964.
- Einhorn LM, Zhao C, Goldstein BA, Raman SR, Cheng J. Impact of State Legislation and Institutional Protocols on Opioid Prescribing Practices Following Pediatric Tonsillectomy. Laryngoscope Investigative Otolaryngology. 2023 May 24;8(3):775-785. PMID: 37342116.
- Boisvert-Plant V, Poulin-Harnois C, Ingelmo P, Einhorn LM. What we know and what we don’t know about the perioperative use of methadone in children and adolescents. Pediatric Anesthesia. 2023 Mar;33(3):185-192. PMID: 36281540.
- Einhorn LM, Andrew BY, Nelsen D, Ames WA. Analgesic Effects of a Novel Combination of Regional Anesthesia following Pediatric Cardiac Surgery: A Retrospective Cohort Study. Journal of Cardiothoracic and Vascular Anesthesia. 2022 Nov;36(11):4054-4061. PMID: 35995635.
- Commesso EA, Osazuwa-Peters N, Einhorn LM, Ji, KY; Greene NH, Eapen RJ, Raynor EM. Opioid and non-opioid analgesic prescribing practices for pediatric adenotonsillectomy in a tertiary care center. International Journal of Pediatric Otolaryngology. 2022 Dec;163:111337. PMID: 36302324.
- Brown K, Carlisle K, Raman SR, Shrader P, Jiao M, Smith MJ, Einhorn LM, Wong CA. Children and the opioid epidemic: Age-stratified exposures, harms, and disparities. Health Affairs. 2020 Oct;39(10):1737-1742. PMID: 33017234.