One-third of children having tonsillectomies benefitted from opioid-free surgery and recovery

Nearly one-third of children who had surgery to remove their tonsils did not need opioids to get adequate pain relief during and after surgery, according to a study presented at the Anesthesiology 2019 annual meeting.

Tonsillectomy is one of the most common pediatric surgical procedures in the U.S., with more than 530,000 performed each year. Children may need this surgery because they experience abnormal breathing patterns while sleeping, including obstructive sleep apnea—a potentially dangerous condition in which breathing gets partially or completely blocked during sleep.

"These patients are especially at risk for breathing difficulties after tonsillectomy, and these risks can increase from using opioids," said Glenn Mann, M.D., lead author of the study and chief of pediatric anesthesiology at Montefiore Medical Center, Bronx, New York. "Opioid use for surgery-related pain is a major risk factor in adult patients for future opioid misuse. Recent research suggests that this relationship may exist for pediatric patients as well."

Yet opioids—powerful painkillers that are known to depress breathing and cause other harmful side effects—are commonly used to control pain in children during and after tonsillectomy.

In the study, researchers reviewed surgical records for 323 children who had their tonsils removed at Montefiore Medical Center during an 18-month period. They compared postoperative administration of opioid and non-opioid analgesics, rates of nausea and vomiting, post anesthesia care unit (PACU) length of stay, and inpatient admission within 30 days for children who did and did not receive opioids during tonsillectomy surgery. Those who did not receive opioids had acetaminophen and/or ibuprofen to manage pain during surgery. Almost all children in both groups were given dexamethasone and dexmedetomidine, which have pain relief properties.

The authors found:

• 32% of all patients studied had a completely opioid-free surgical experience
• More than 40% of patients did not receive opioids during surgery. Of those, a majority (73%) also did not require opioids postoperatively.
• About one-third of patients in both groups - those who received opioids during surgery vs. those who did not - didn't require any additional pain medication in the PACU prior to discharge (28% vs. 34% respectively)
• Length of stay in the PACU, a way to measure postoperative pain and other complications, was similar in both groups (143 minutes for children who received opioids during surgery vs. 147 minutes for those who didn't)

"There are a number of studies that look at pain management for tonsillectomy and how to limit opioids. However, few have examined a completely opioid-free technique," said Dr. Mann. "We believe this research is important because it has the potential to offer physician anesthesiologists a safe and effective regimen for tonsillectomy that is opioid-free and potentially reduces risks associated with opioid use."