| Summary: | Faris Alghamdi,1 Catherine Roth,1 Kris R Jatana,2 Charles A Elmaraghy,2 Julie Rice,1 Joseph D Tobias,1 Arlyne K Thung1 1Department of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital and the Ohio State University College of Medicine, Columbus, OH, USA; 2Department of Otolaryngology and Head & Neck Surgery, Nationwide Children’s Hospital and the Ohio State University, Columbus, OH, USACorrespondence: Arlyne K ThungDepartment of Anesthesiology & Pain Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH 43205, USATel +1 614 722-4200Fax +1 614 722-4203Email Arlyne.Thung@Nationwidechildrens.orgIntroduction: An opioid-sparing anesthetic involves a multi-modal technique with non-opioid medications targeting different analgesic pathways. Such techniques may decrease adverse effects related to opioids. These techniques may be considered in patients at higher risk for opioid-related adverse effects including obstructive sleep apnea or sleep disordered breathing.Methods: A prospective, pilot study was performed in 10 patients (3– 8 years of age), presenting for adenoidectomy. The perioperative regimen included oral dextromethorphan (1 mg/kg) and acetaminophen (15 mg/kg) plus single boluses of intraoperative dexmedetomidine (0.5 μg/kg) and ketamine (0.5 mg/kg). Pain scores were assessed in the post anesthesia care unit (PACU) using the FLACC (Face, Legs, Activity, Cry, Consolability) scale. Patients with a pain score > 4 received fentanyl as needed. PACU time, pain scores, and parent satisfaction were recorded. Postoperatively, patients were instructed to use oral acetaminophen or ibuprofen every 6 hours as needed for pain.Results: The study cohort included 10 patients, 3– 8 years of age. All patients had opioid-free anesthetic care. PACU time ranged from 24 to 102 minutes (median: 56 minutes). FLACC pain scores were 0 for all PACU assessments. Nine patients were discharged home and 1 patient had a planned overnight admission. Following hospital discharge, the pain scores were satisfactory during the 72-hour study period and 90% of the patients’ guardians were satisfied or highly satisfied with their child’s pain control.Conclusion: This opioid-sparing approach provided safe and effective pain control as well as parental satisfaction following adenoidectomy in children. Additional prospective studies are needed to determine whether this regimen is effective in a larger cohort of patients with and for other otolaryngology procedures.Keywords: opioid, sparing, analgesia, pediatric, adenoidectomy
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