(0240) Outcomes of an Opioid-Sparing Posttonsillectomy Pain Regimen: A Single Institution Experience

Introduction: Controlling post-tonsillectomy pain is challenging and the use of opioids has risks of nausea, constipation, and respiratory depression favoring non-opioid regimens when possible. We seek to examine the outcomes of an opioid-sparing, extended oral steroid postoperative protocol and its effects on rates of readmission.

Methods: A quality improvement initiative at a single institution undertaken in July 2023 to reduce post-tonsillectomy opioid prescriptions. Previously, pediatric patients undergoing tonsillectomy were prescribed postoperative pain regimen consisting of weight-based acetaminophen, ibuprofen, and oral dexamethasone (0.5 mg/kg/dose; max 8 mg) to be administered on postoperative day 3. Patients over 3 years old were also prescribed oral oxycodone. Beginning July 2023, the change included an extended oral steroid course dosed as above to take on postoperative day 2, 4, and 6 and opioids only for select teenagers and patients with contraindications to opioid-sparing regimen. Patient charts from January to November 2023 were then retrospectively reviewed. Using Fisher's exact test, opioid prescriptions and rates of readmission were compared between pre and post-opioid sparing groups, statistical significance determined with p < 0.05.

Results: In total, 411 patients were in the pre-opioid sparing group (January-June 2023) and 433 patients were in the post-opioid sparing group (July-November 2023). The introduction of opioid-sparing protocol led to a significant decrease in opioid prescriptions from 55% to 22% (p < 0.001). There was no significant difference in rates of readmissions for pain/dehydration (pre: 4%, post: 2%; p = 0.07) or bleeding (pre: 5%, post: 3%; p = 0.48).

Conclusions: Our opioid-sparing protocol with extended oral steroid had no significant effect on rates of readmission for pain/dehydration or bleeding, demonstrating a reasonable alternative to opioids for pain control in pediatric patients undergoing tonsillectomy.