Author(s)
Ethan Frank, MD
Victoria Cress, BA
Shannon Calaguas, MD
Ivan Vegar, BS
Wilson Lao, MD
Owen Vanderwerf, BS
Michael Reimer, BS
Vikrum Thimmappa, MD
Tsungju O-Lee, MD
Affiliation(s)
Otolaryngology--Head & Neck Surgery, Loma Linda Univ. Children's Hosp., Loma Linda, CA, Loma Linda Univ. Sch. of Med., Loma Linda, CA, Otolaryngology--Head & Neck Surgery, Loma Linda Univ. Sch. of Med., Loma Linda, CA.;
Abstract:
Introduction: Despite a push for opiate minimization in pediatric populations since the 2013 black box warning against codeine in children, opiate utilization remains frequent in pediatric post-operative patients. Opiates present significant risk to patient safety, particularly in children, and should be avoided whenever possible. We report outcomes of an opiate sparing post-tonsillectomy pain regimen.
Methods: Retrospective review of all pediatric patients having tonsillectomy and adenoidectomy at a single academic center between October 2017 and July 2021. Opiate avoiding pain regimen consisted of around the clock Tylenol and ibuprofen with a three-day course of oral steroids used for breakthrough pain. Opiates prescriptions were limited to pain refractory to oral steroids. Historical control of opiate prescription per provider preference and judgement was utilized for comparison.
Results: Mid-study analysis showed narcotic prescription rates of 3% in the opiate sparing cohort compared to 86% in the historical cohort (p<0.001). Steroid prescription rates in the opiate sparing cohort were 6.6%. There was no significant difference in the rates of readmission (4% versus 5.3%; p=0.5), return to the emergency room (4.3% versus 4%; p=0.9), or clinical dehydration (2% versus 1.7%; p=0.9) between the opiate-sparing and historical cohorts. On study conclusion, final data will be presented using multilevel modeling to assess for significant differences in outcomes of interest.
Conclusion: While opiate prescribing practices in pediatric patients vary widely, given the known, significant side effects related to opiate use, reduction in opiate prescriptions in the pediatric population is of paramount importance. Our results show that strict opiate sparing protocols can be utilized after tonsillectomy without increase in post-operative complications related to inadequate pain control or oral intake. While our data do not directly assess patient—or parent—satisfaction with pain control measures, it does suggest the appropriate use of over the counter pain medications and judicious steroid prescriptions can adequately and safely control post-tonsillectomy pain while nearly eliminating the need for opiate medications.