Cohort study of opioid utilization in post-tonsillectomy pediatric patients

Prospective observational cohort study at a tertiary care academic center to evaluate the post-operative use of oxycodone in pediatric tonsillectomy patients and caregiver knowledge of opioid disposal.

Pediatric patients 6-18 years old undergoing tonsillectomy were enrolled. Patients were excluded if they required prolonged inpatient care, had a history of organ transplantation, chronic pain or narcotic use, congenital or chromosomal disorders, inability to take acetaminophen or ibuprofen, and other significant medical diagnoses that could potentially alter postoperative pain management. All patients were prescribed a standard amount of oxycodone to be used for breakthrough pain in addition to ibuprofen and acetaminophen. Data on patient demographics, details of their tonsillectomy, pain ratings, and caregiver understanding of opioid use and disposal were collected and analyzed.

A total of 46 patients were enrolled with data collected on 38 patients and a mean age of 14.2 years. There were 32 patients (70%, [32/46]) that were opioid naïve. Oxycodone provided excellent pain control in 70% of patients, and 10% of patients returned to the hospital for further pain-associated issues. Near-significant increased opioid consumption was seen in patients with tonsillitis (p = 0.02, α = 0.0167), and significant increase in non-Hispanic patients (p = 0.001, α = 0.0167). 61% of caregivers lacked plans for opioid disposal after the postoperative period was complete.

Ibuprofen and acetaminophen with oxycodone for breakthrough pain achieved effective pain relief. Increased opioid use was observed in non-Hispanic patients. Notably, families were broadly unaware of safe disposal methods for leftover opioids. Our study highlights need for more comprehensive counseling on opioid usage in children post-tonsillectomy.