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Sustaining standardized opioid prescribing practices after pediatric tonsillectomy.

Holly Cordray1, Kristan Alfonso2, Clarice Brown2

  • 1Children's Healthcare of Atlanta at Egleston, Atlanta, GA, USA; Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine, Atlanta, GA, USA.

International Journal of Pediatric Otorhinolaryngology
|June 24, 2022
PubMed
Summary

A new standardized pain management protocol significantly reduced opioid prescriptions after pediatric tonsillectomy. This opioid-sparing approach did not increase patient returns for pain or other postoperative issues.

Keywords:
Non-narcotic analgesicsOpioid analgesicsPain managementPediatricsQuality improvementTonsillectomy

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Area of Science:

  • Pediatric surgery
  • Pain management
  • Pharmacology

Background:

  • Opioid prescribing after pediatric tonsillectomy is inconsistent.
  • Opioids may not offer superior pain relief compared to over-the-counter alternatives.

Purpose of the Study:

  • To assess if a standardized, opioid-sparing analgesic protocol reduces opioid prescriptions post-tonsillectomy.
  • To determine if this protocol impacts patient outcomes.

Main Methods:

  • A quality improvement project implemented an age- and weight-based electronic order set for analgesia post-tonsillectomy.
  • Non-opioid analgesics (acetaminophen, ibuprofen) were prioritized, with opioids reserved for breakthrough pain.
  • Opioid prescription rates and quantities were compared pre- and post-standardization.

Main Results:

  • Opioid prescriptions decreased from 64.9% to 33.5% post-standardization (P < .001).
  • Average opioid quantity per prescription decreased by 16.3 doses (P < .001).
  • Returns to the system for postoperative issues did not significantly change (P = .33).

Conclusions:

  • A standardized, age- and weight-based analgesic protocol effectively reduced opioid prescribing after pediatric tonsillectomy.
  • This approach limited pediatric opioid exposure without compromising patient safety or increasing postoperative returns.