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Opioid Analgesia Following Pediatric Adenotonsillectomy: A Randomized Clinical Trial

Rachel L Whelan1,2, Jennifer L McCoy1, Leonid Mirson2

  • 1UPMC Children's Hospital of Pittsburgh, Division of Pediatric Otolaryngology, Pittsburgh, Pennsylvania, USA.

Otolaryngology--Head and Neck Surgery : Official Journal of American Academy of Otolaryngology-Head and Neck Surgery
|May 21, 2025
PubMed

Insights

Many children undergoing adenotonsillectomy (AT) do not need opioid pain relief. Nonopioid pain management is as effective as opioid use, with similar outcomes for pediatric patients.

Area of Science:

  • Pediatric Surgery
  • Pain Management
  • Anesthesiology

Background:

  • Adenotonsillectomy (AT) is a common pediatric surgical procedure.
  • Postoperative pain management is crucial for recovery.
  • The role of opioids versus nonopioids in pediatric AT pain is debated.

Purpose of the Study:

  • To compare the safety and efficacy of nonopioid versus opioid pain management after pediatric adenotonsillectomy (AT).

Main Methods:

  • An open-label randomized controlled trial was conducted at a tertiary care children's hospital.
  • Pediatric patients aged 3-17 years undergoing AT were randomized to receive either nonopioids (acetaminophen and ibuprofen) or opioids (acetaminophen, ibuprofen, and oxycodone).
  • Pain scores, emergency department visits, hospital readmissions, and posttonsillectomy hemorrhage (PTH) were compared.

Main Results:

  • No significant differences in mean pain scores were observed between the nonopioid and opioid groups.
  • Opioid consumption varied by age, with older children (13-17 years) consuming opioids more frequently.
  • Rates of emergency department visits, hospital readmissions, and PTH did not differ significantly between the groups.

Conclusions:

  • Many children, especially those under 8 years old, do not require opioid analgesics after AT.
  • Nonopioid pain management provides comparable outcomes to opioid use in pediatric AT.
  • Opioid prescriptions should be limited or avoided for pediatric AT patients.
Abstract

Keywords:
opioid prescriptionpediatric opioidpostoperative opioidpostoperative paintonsillectomy pain

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