Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study
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...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2020-11-01
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| Series: | Journal of Pain Research |
| Subjects: | |
| Online Access: | https://www.dovepress.com/opioid-sparing-anesthetic-technique-for-pediatric-patients-undergoing--peer-reviewed-article-JPR |
| _version_ | 1818405753554206720 |
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| author | Alghamdi F Roth C Jatana KR Elmaraghy CA Rice J Tobias JD Thung AK |
| author_facet | Alghamdi F Roth C Jatana KR Elmaraghy CA Rice J Tobias JD Thung AK |
| author_sort | Alghamdi F |
| collection | DOAJ |
| description | 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 |
| first_indexed | 2024-12-14T09:01:03Z |
| format | Article |
| id | doaj.art-81ac167c8f8b4195be1112326eaa5760 |
| institution | Directory Open Access Journal |
| issn | 1178-7090 |
| language | English |
| last_indexed | 2024-12-14T09:01:03Z |
| publishDate | 2020-11-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Pain Research |
| spelling | doaj.art-81ac167c8f8b4195be1112326eaa57602022-12-21T23:08:48ZengDove Medical PressJournal of Pain Research1178-70902020-11-01Volume 132997300459486Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot StudyAlghamdi FRoth CJatana KRElmaraghy CARice JTobias JDThung AKFaris 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, adenoidectomyhttps://www.dovepress.com/opioid-sparing-anesthetic-technique-for-pediatric-patients-undergoing--peer-reviewed-article-JPRopioidsparinganalgesiapediatricadenoidectomy |
| spellingShingle | Alghamdi F Roth C Jatana KR Elmaraghy CA Rice J Tobias JD Thung AK Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study Journal of Pain Research opioid sparing analgesia pediatric adenoidectomy |
| title | Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study |
| title_full | Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study |
| title_fullStr | Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study |
| title_full_unstemmed | Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study |
| title_short | Opioid-Sparing Anesthetic Technique for Pediatric Patients Undergoing Adenoidectomy: A Pilot Study |
| title_sort | opioid sparing anesthetic technique for pediatric patients undergoing adenoidectomy a pilot study |
| topic | opioid sparing analgesia pediatric adenoidectomy |
| url | https://www.dovepress.com/opioid-sparing-anesthetic-technique-for-pediatric-patients-undergoing--peer-reviewed-article-JPR |
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