# Opioid Analgesia Following Pediatric Adenotonsillectomy: A Randomized Clinical Trial

## TL;DR

This study found that nonopioid pain management is as effective as opioids for children after adenotonsillectomy, especially in younger patients.

## Contribution

The study provides evidence that opioid prescriptions can be limited or avoided after pediatric adenotonsillectomy without compromising pain control.

## Key findings

- Pain scores were similar between opioid and nonopioid groups before and after analgesics.
- Opioid consumption increased with age, with 63% of adolescents using opioids compared to 25% of younger children.
- Outcomes like ED visits, readmissions, and posttonsillectomy hemorrhage were not significantly different between groups.

## Abstract

To compare the safety and efficacy of nonopioid versus opioid pain management following adenotonsillectomy (AT) among pediatric patients.

An open‐label randomized controlled trial.

Tertiary care children's hospital.

Patients aged 3 to 17 years undergoing AT were eligible. Participants were randomly assigned to receive either acetaminophen and ibuprofen (nonopioid group) or acetaminophen, ibuprofen, and oxycodone (opioid group). Pain scores and prevalence of emergency department (ED) visits, hospital readmission, and posttonsillectomy hemorrhage (PTH) were compared between groups.

From January 2019 to March 2020, 267 patients were enrolled and randomly assigned; 144 completed a postoperative pain diary. Of the 144, 69 (48%) patients received an opioid prescription, and 75 (52%) did not. Mean pain scores before (opioid: 5.78, 95% CI: 5.29‐6.27 vs nonopioid: 5.66, 95% CI: 5.20‐6.12) and after (opioid: 2.33, 95% CI: 1.89‐2.78 vs nonopioid: 2.24, 95% CI: 1.82‐2.66) analgesics were not significantly different between opioid and nonopioid groups. Although 7/75 (9%) from the nonopioid group crossed over and requested opioids, only 43/69 (62%) randomly assigned to receive opioid prescription consumed opioids. The rate of opioid consumption increased with increasing age: 18/71 (25%) patients aged 3 to 7 years, 22/57 (39%) 8 to 12 years, and 10/16 (63%) 13 to 17 years, P = .015. Differences in ED visits, hospital readmissions, and PTH between opioid and nonopioid groups were not significant.

Many children do not require opioid analgesics following AT, particularly children less than 8 years of age. Postoperative pain scores and outcomes were similar in opioid versus nonopioid groups. Opioid prescriptions should be limited or avoided altogether after pediatric AT.

Title: Nonopioids for analgesia after adenotonsillectomy in children; ID: NCT03618823, Clinicaltrials.gov.