Pediatric anesthesia & critical care
Decreasing Opioid Usage in Pediatric Cholecystectomy Through Care Standardization: A Quality Improvement Project Using Enhanced Recovery After Surgery Protocols
Authors' conclusion
Standardizing care through enhanced recovery after surgery protocols effectively reduces opioid use in pediatric laparoscopic cholecystectomy without increasing mean postoperative pain scores, postoperative nausea and vomiting, pruritus, or hospital length of stay.
Study context
- Population
- Pediatric laparoscopic cholecystectomy patients at a 443-bed pediatric academic hospital
- Comparison
- ERAS protocol vs pre-ERAS perioperative care
- Outcome
- Opioid use in MME (aim: 25% reduction)
- Follow-up
- 32 months
Methodological detailsModel for Improvement, pre-post comparison, single-centre, 5 months testing and implementing the protocol, then 27 months of full implementation
- Model for Improvement
- Pre-post comparison
- Single-centre
- 5 months testing and implementing the protocol, then 27 months of full implementation
Main finding
As reported in the abstract
Opioid use (MME)
MME decreased after full ERAS protocol implementation
27%
Further findings
Hospital LOS · balancing measure
Mean
| Outcome | Pre-ERAS | Post-ERAS |
|---|---|---|
| Pain scoresBalancing measure | 4.69 (95% CI 4.32–5.06) | 4.10 (95% CI 3.84–4.36) |
Safety
PONV incidence
- PONV incidence decreased from 18% (95% CI: 11.7-26.7) to 15% (95% CI: 9.3-23.3)
Pruritus incidence
- Pruritus incidence declined from 6% (95% CI: 2.8-12.5) to 5% (95% CI: 2.2-11.2)
30-day readmission rate
- Unchanged; sole readmission attributed to constipation
Original publication
Decreasing Opioid Usage in Pediatric Cholecystectomy Through Care Standardization: A Quality Improvement Project Using Enhanced Recovery After Surgery Protocols. Paediatr Anaesth. Published 2 April 2025. doi:10.
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