Related Experiment Video

Updated: Jan 31, 2026

Whole-body PET/MRI of Pediatric Patients: The Details That Matter
10:02

Whole-body PET/MRI of Pediatric Patients: The Details That Matter

Published on: December 19, 2017

15.3K

Opioid prescription and postoperative outcomes in pediatric patients

Rachel L Whelan1, Jennifer McCoy1, Leonid Mirson1

  • 1Department of Otolaryngology, Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, U.S.A.

The Laryngoscope
|December 27, 2018
PubMed

Insights

Mandated opioid consent forms for adenotonsillectomy reduced opioid prescriptions in pediatric patients. This change did not increase adverse postoperative outcomes, supporting system-level opioid reduction strategies.

Area of Science:

  • Pediatric Otolaryngology
  • Pain Management
  • Health Policy

Background:

  • Adenotonsillectomy is a common pediatric procedure often associated with significant postoperative pain.
  • Opioid analgesics are frequently prescribed for pain management, raising concerns about overuse and potential adverse effects.
  • The implementation of mandated opioid consent forms aims to standardize and potentially reduce opioid prescribing practices.

Purpose of the Study:

  • To evaluate the impact of mandated opioid consent forms on the quantity of opioids prescribed after pediatric adenotonsillectomy.
  • To assess whether changes in opioid prescribing influenced postoperative outcomes, including complications and healthcare utilization.
  • To determine the effectiveness of a systems-based approach to opioid stewardship in pediatric surgery.

Main Methods:

  • A retrospective cohort study design was employed, comparing patients undergoing adenotonsillectomy before and after the implementation of mandated opioid consent forms.
  • Data collected included patient demographics, operative details, weight-based opioid dosages, and postoperative outcomes such as nursing calls, emergency department visits, hospital readmissions, and bleeding rates.
  • Statistical analysis was performed to compare outcomes between the pre-consent and post-consent groups.

Main Results:

  • Opioid prescriptions were provided to 70.3% of patients (112 pre-consent, 99 post-consent).
  • The mean total opioid dosage prescribed (mg/kg) was significantly lower post-consent (3.2 ± 4.7) compared to pre-consent (4.8 ± 5.6; P = .003).
  • No significant differences were observed in nursing calls or emergency department visits; however, pre-consent patients experienced higher rates of hospital readmission for pain/dehydration and bleeding concerns.

Conclusions:

  • Implementation of mandated opioid consent forms was associated with a significant reduction in opioid prescriptions for pediatric adenotonsillectomy patients.
  • This reduction in opioid prescribing did not lead to an increase in adverse postoperative outcomes, such as complications or readmissions.
  • These findings support the use of mandated consent forms as a systems-level strategy to minimize opioid prescribing in pediatric surgical populations.
Abstract

Keywords:
Postoperative painopioid prescriptionpediatric opioidpostoperative opioidtonsillectomy pain

More Related Videos

Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model04:55

Author Spotlight: Simulating Pediatric Cardiac Surgery Using a Neonatal Piglet Model

Published on: May 26, 2023

1.4K
Surgical Correction for Pediatric Epiblepharon and Trichiasis03:59

Surgical Correction for Pediatric Epiblepharon and Trichiasis

Published on: July 8, 2025

578

Related Concept Videos

Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
261
Pharmacokinetics in Pediatric Patients: Drug Distribution01:17

Pharmacokinetics in Pediatric Patients: Drug Distribution

Drug distribution in the pediatric population exhibits unique challenges and considerations due to the physiological differences between children, particularly neonates and infants, and adults. A crucial aspect of pediatric pharmacology is understanding how these differences impact the pharmacokinetics of various drugs, necessitating age-specific dosing strategies to ensure efficacy and safety.Neonates and infants have a higher total body water content, ~75%–90% of their body weight,...
304
Pharmacokinetics in Pediatric Patients: Drug Metabolism01:24

Pharmacokinetics in Pediatric Patients: Drug Metabolism

In pediatric care, understanding the nuances of hepatic drug metabolism is crucial, as it significantly differs from that of adults. This divergence is primarily due to the developmental stage of drug-metabolizing enzymes, which affects how medications are processed in the body. In neonates, for instance, the activity of Phase I enzymes—critical for the initial breakdown of drugs—is markedly reduced, functioning at just 20–40% of the levels seen in adults. This reduction poses...
223
Opioid Analgesics: Synthetic and Semisynthetic Opioids01:15

Opioid Analgesics: Synthetic and Semisynthetic Opioids

Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
1.1K
Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption01:23

Pharmacokinetics in Pediatric Patients: Overview and Drug Absorption

Understanding the physiological differences in the pediatric population is crucial for effective pharmacotherapy. Neonates, infants, and children exhibit significant variations in gastric pH, gastric emptying time, intestinal transit time, and biliary function. These variations profoundly affect oral drug absorption, necessitating a nuanced approach to pediatric dosing.Neonates present with a unique physiological profile, having a gastric pH greater than 4 and faster and more irregular gastric...
296
Opioid Receptors: Overview01:22

Opioid Receptors: Overview

Opioid receptors, including the mu (μ, MOR), delta (δ, DOR), and kappa (κ, KOR) types, belong to the rhodopsin family of G protein-coupled receptors. These receptors are located throughout the central and peripheral nervous systems and in non-neuronal tissues such as macrophages and astrocytes. Opioid receptor ligands can be categorized into agonists or antagonists. Highly selective agonists include [d-Ala2, MePhe4, Gly(ol)5]-enkephalin or DAMGO for MOR, [D-Pen2,...
4.3K