Optimizing pediatric tonsillectomy outcomes with an opioid sparing anesthesia protocol: Learning and continuously...

Area of Science:

• Pediatric Anesthesiology
• Quality Improvement Science
• Surgical Outcomes Research

Background:

• Opioid use in pediatric tonsillectomy contributes to adverse effects.
• Optimizing anesthesia protocols is crucial for ambulatory surgery centers.
• Data-driven quality improvement cycles can enhance patient care.

Purpose of the Study:

• To iteratively improve an opioid-sparing anesthesia protocol for tonsillectomy.
• To reduce opioid requirements in the post-anesthesia care unit (PACU).
• To evaluate the impact of protocol refinements on pain, nausea, and length of stay.

Main Methods:

• Utilized Plan-Do-Study-Act (PDSA) cycles for protocol refinement from 2015-2023.
• Analyzed data from 5654 tonsillectomy cases using statistical process control charts.
• Monitored PACU opioid administration, pain scores, nausea/vomiting, and length of stay.

Main Results:

• Achieved a decrease in PACU intravenous opioid administration to below 10%.
• Postoperative nausea and vomiting incidence improved.
• Average PACU length of stay increased slightly, but reoperation rates remained unchanged.

Conclusions:

• Refined opioid-sparing anesthesia protocols effectively reduce opioid consumption.
• The protocol achieved favorable pain and nausea/vomiting outcomes.
• Minimal impact on PACU length of stay suggests a safe and effective approach.