Otolaryngology

Data Analysis

Harbaugh et al. 2019 (Level 3 evidence)

• DOI: 10.1001/jamasurg.2019.2529 Included Procedures: Adenoidectomy
• April 2018 – November 2018
• 81 Patients
• 94% of patients (76/81) were not prescribed or did not use opioid following surgery

Supporting Literature

Viitanen et al. 2003 (Level 1 evidence)

• DOI: http://doi.org/10.1093/bja/aeg196
• Randomized controlled trial with 160 children (1yo-6yo) undergoing adenoidectomy were randomized to receive one of the following rectal medications: acetaminophen; ibuprofen; acetaminophen with ibuprofen; or placebo.
• Intraoperative use of rectal acetaminophen and ibuprofen reduces need for oral analgesia after discharge.

Alghamdi et al. 2020 (Level 3 evidence)

• DOI: http://doi.org/10.2147/JPR.S281275
• 10 patients (3yo-8yo) were given opioid-free anesthesia for adenoidectomy and pain scores were measured.
• Opioids can be safely eliminated without sacrificing satisfaction with pain management.

Harbaugh et al. 2019 (Level 3 evidence)

• DOI: 10.1001/jamasurg.2019.2529
• Analyzed data from 404 children undergoing umbilical or epigastric herniorrhaphy; laparoscopic appendectomy; inguinal herniorrhaphy and/or hydrocelectomy; adenoidectomy; circumcision; percutaneous pinning for elbow fracture or scrotal-incision orchiopexy at a single institution between April 2018- November 2018
• 22% of patients received a discharge opioid with a median of 10 doses.
• Nearly 90% of patients undergoing an adenoidectomy were not prescribed or did not use an opioid.
• 88% of patients reported acetaminophen use and 78% reported ibuprofen use for a median of 3 days.
• Conclusion: Postoperative opioid prescribing for children is unnecessary following adenoidectomy with adequate analgesia on nonopioid analgesics

Data Analysis

• Included Procedures: Cochlear Implant, Tympanoplasty and mastoidectomy, Mastoidectomy, Tymplanoplasty
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine
• March 2021 – August 2022
• 40 Opioid Naïve Patients
• Pain Score (median): 2
• Satisfaction with Pain Management (median): 5

Data Analysis

• Included Procedures: Tonsillectomy, Tonsillectomy and Adenoidectomy
• Patient Reported Outcomes data collected via C.S. Mott Children’s Hospital, Michigan Medicine
  March 2021 – August 2022
• 138 Opioid Naïve Patients
  
• Pain Score (median): 3
• Satisfaction with Pain Management (median): 5

Supporting Literature

Commesso et al. 2022 (Level 2 evidence)

• DOI: https://doi.org/10.1016/j.ijporl.2022.111337
• Analyzed data from pediatric patients <18yo undergoing adenotonsillectomy at a single tertiary academic healthcare institution between 2013-2016.
• 69% prescribed opioids and 51% prescribed non-opioid analgesics.
• Patients prescribed opioids had a higher rate of emergency department presentation (17.4% compared to 11.3%).
• For patients presenting to the emergency department (ED) within 30 days, 77% had an opioid prescription and 19% had an acetaminophen prescription at the time of surgery.
• Recommendation = prescribe acetaminophen to reduce 30-day ED presentation rate.

Supporting Literature

Chua et al. 2022 (Level 2 evidence)

• DOI: http://doi.org/10.1001/jamanetworkopen.2022.19701
• Analyzed data from 237 individuals age 12-50 undergoing tonsillectomy at a single medical center from 1 October 2019- 31 July 2021.
• Mean number of doses prescribed post-intervention = 16.1.
• Recommendation for prescription = 12 doses