Perioperative interdisciplinary approach for reduction of opioid use in pediatric tonsillectomy: Protocol using dexmedetomidine and bupivicaine as adjunct agents

American Journal of Otolaryngology
Austin N DeHartKelley M Dodson

Abstract

Pediatric tonsillectomy is a common procedure now being performed most often for patients with obstructive sleep apnea, which has been associated with increased sensitivity to the respiratory side effects of opioid medications. This study investigates a strategy to decrease the use of opiate medications in a particularly vulnerable population. Describe an interdisciplinary approach between Otolaryngologists and Anesthesiologists to decrease opiate use in tonsillectomy patients. Demonstrate safety of this protocol. Evaluate the effect of the protocol on intraoperative need for opiate medications and inhaled anesthetic use. Perform cost analysis of the protocol. Retrospective case-control study with cost analysis. Tertiary Care Hospital. Pediatric patients undergoing tonsillectomy at a tertiary care hospital. Preoperative and intraoperative dexmedetomidine with local bupivacaine injection into the tonsillar fossa. Intraoperative need for sevoflurane, opiate, and propofol. Post-operative pain scores, and utilization of post-operative opiate, acetaminophen, and ibuprofen pain medications. Post-operative adverse events. Cost analysis of protocol. This protocol led to a decrease in intraoperative opiate use by 49.6%, a decrease in in...Continue Reading

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