Franz AM, et al. In Pursuit of an Opioid-Free Pediatric Ambulatory Surgery Center: A Quality Improvement Initiative. Anesth Analg. 2021 Mar 1;132(3):788-797. doi: 10.1213/ANE.0000000000004774. PMID: 32282383. In the March issue of A&A, Franz, et al. from Seattle Children’s have published their experience (i.e., QI initiative) trying to replace intraoperative and postoperative opioid administration with alternatives, such as dexmedetomidine, non-steroidal anti-inflammatories (NSAIDs), and/or regional analgesia, in their freestanding surgicenter. Their overarching goal was to determine whether it was possible to “minimize perioperative opioids in pediatric ambulatory surgical patients without compromising patient outcomes or value”. The team performed an 18-month-long QI improvement process, from January 2017 and June 2019, that included nearly 11,000 children for analysis. Their main intervention during that time was to replace intraoperative morphine and acetaminophen with dexmedetomidine and ibuprofen. This practice was based on their previous
We should be careful not to swing the pendulum too far as is always done when something "new" comes up. There has not been any evidence that intraop opioids is an issue but rather postop. So though you need to plan for postop pain, avoiding opioids totally is not reasonable or feasible. I may be old school but I still give T&A patients opioids and so far there has not been any who had respiratory issues postop, even the ones who were admitted for overnight monitoring based on criteria (e.g., age, severe OSA, obesity). Caveat, everything should be administered judiciously and with thought.
We should be careful not to swing the pendulum too far as is always done when something "new" comes up. There has not been any evidence that intraop opioids is an issue but rather postop. So though you need to plan for postop pain, avoiding opioids totally is not reasonable or feasible. I may be old school but I still give T&A patients opioids and so far there has not been any who had respiratory issues postop, even the ones who were admitted for overnight monitoring based on criteria (e.g., age, severe OSA, obesity). Caveat, everything should be administered judiciously and with thought.