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The Association of Preoperative Hydrocodone and Acetaminophen With Total Opioid Requirement, and Pain Experience in

Adam C Adler1,2, Robert C Vernick1,3, Anika Tanwani4

  • 1Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Houston, Texas, USA.

Acta Anaesthesiologica Scandinavica
|July 25, 2025
PubMed

Insights

Preoperative hydrocodone with acetaminophen improved pain scores and reduced discharge times in children undergoing adenotonsillectomy. Total opioid consumption did not significantly increase, with gains limited to the preoperative dose.

Area of Science:

  • Pediatric Anesthesiology
  • Pain Management
  • Pharmacology

Background:

  • Pre-emptive analgesia may reduce perioperative opioid use and improve pain.
  • Evidence for pre-emptive analgesia benefits, especially in children, is conflicting.
  • This study investigated hydrocodone with acetaminophen's effect on opioid consumption in pediatric adenotonsillectomy.

Purpose of the Study:

  • To examine the association between preoperative hydrocodone with acetaminophen and total opioid consumption in children undergoing adenotonsillectomy.
  • To assess the impact on postoperative pain experience and discharge time.
  • To evaluate the safety and efficacy of pre-emptive analgesia in this pediatric surgical population.

Main Methods:

  • Retrospective cohort study of 1082 children undergoing adenotonsillectomy.
  • Exposure: Preoperative hydrocodone with acetaminophen (HA).
  • Outcomes: Total perioperative opioid consumption (oral morphine equivalents - OME), PACU pain, and discharge time.

Main Results:

  • No significant difference in total intraoperative and postoperative OME between groups (0.49 vs 0.50 mg/kg).
  • Preoperative HA associated with shorter PACU discharge time (30.0 vs 39.0 min) and higher likelihood of pain scores 0-3 (OR 2.16).
  • Preoperative HA increased likelihood of zero pain score in PACU (OR 1.85).

Conclusions:

  • Preoperative hydrocodone with acetaminophen improved PACU pain experience and reduced discharge time.
  • Total opioid consumption increase was limited to the preoperative dose.
  • Pre-emptive analgesia with HA demonstrates benefits in pediatric adenotonsillectomy patients.
Abstract

Keywords:
adenotonsillectomyopioid reductionopioidspediatricspre‐emptive analgesiarecovery

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