Pediatric anesthesia & critical care
Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real‐world data
Authors' conclusion
The continued refinement of our opioid sparing anesthesia protocol has led to reduced perioperative and home opioid use, stable maximum post anesthesia care unit pain scores, and improved postoperative nausea and vomiting rates, with only a slight increase in mean post anesthesia care unit length of stay.
Study context
- Population
- Children undergoing tonsillectomy with or without adenoidectomy at a pediatric ambulatory surgical center, 2015–2023
- Participants
- 5,654 cases
- Comparison
- Iteratively refined opioid sparing/opioid free anesthesia protocol over time
- Outcome
- Percent of patients requiring IV opioid in the PACU
Methodological detailsPlan-Do-Study-Act cycles, statistical process control charts, single ambulatory surgical center, From 1/2015 through 12/2023: nine perioperative, three postoperative prescription and four general enhanced recovery Plan-Do-Study-Act cycles
- Plan-Do-Study-Act cycles
- Statistical process control charts
- Single ambulatory surgical center
- From 1/2015 through 12/2023: nine perioperative, three postoperative prescription and four general enhanced recovery Plan-Do-Study-Act cycles
Main finding
As reported in the abstract
IV opioid administered in the PACU
Initially rose with opioid free anesthesia launch, then decreased below the target
10%
Secondary outcomes
Maximum PACU pain score
- Rose from mean 3.6 to 4.5, then returned to baseline
- 3.5
PONV in the PACU
- Incidence of postoperative nausea and/or vomiting improved
Safety
PACU LOS
- Average PACU LOS increased with opioid free anesthesia
- 10 min
Prolonged PACU stay (>120 min) and 30-day reoperation
- Unchanged
Original publication
Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously improving with real‐world data. Paediatr Anaesth. Published 30 August 2024. doi:10.
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