# Comparison of Opioid Consumption During Paediatric Anaesthesia with and Without a Mandatory Protocol: A Retrospective Cohort Study

## TL;DR

A study found that using a mandatory protocol during pediatric anesthesia reduced opioid use without affecting hospital stay length.

## Contribution

This study demonstrates that a mandatory multimodal anesthesia protocol reduces opioid consumption in pediatric laparoscopic surgery.

## Key findings

- Patients under a mandatory protocol received significantly less fentanyl compared to those managed at clinicians' discretion.
- Use of non-opioid analgesics like acetaminophen and metamizole increased significantly in the protocol group.
- There was no significant difference in hospital stay length between the two groups.

## Abstract

Background: Opioids remain the most effective component of systemic analgesia and are considered safe and beneficial when administered at the lowest effective dose. Nevertheless, their potential adverse effects may diminish the quality of the postoperative period or, in some cases, lead to life-threatening complications. This analysis examines whether the mandatory implementation of a standardised protocol offers opioid-sparing potential. Methods: In this single-centre retrospective cohort study, intraoperative opioid consumption during laparoscopic appendectomy was compared between patients anaesthetised according to a standardised protocol (n1 = 132) and those managed at clinicians’ discretion in line with good medical practice (n2 = 212). Length of hospital stay and use of intraoperative non-opioid analgesics were also assessed. Results: The total fentanyl dose administered during anaesthesia was significantly lower in the standardised protocol cohort compared to the cohort without a protocol: 3.13 μg·kg−1 (IQR: 2.98–4.08) vs. 5.19 μg·kg−1 (IQR: 3.89–6.67), p < 0.001. In the protocol cohort, the percentage of patients who received acetaminophen and metamizole was significantly higher—increasing by 57% and 23%, respectively (p < 0.001). No significant inter-cohort difference was observed in terms of length of hospital stay. Conclusions: The use of a mandatory anaesthetic protocol based on a multimodal approach had an opioid-sparing effect in children undergoing laparoscopic appendectomy. This retrospective analysis was approved by the Ethics Committee of the Medical University of Warsaw (identifier: AKBE/118/2025; date of acceptance: 12 May 2025), and the primary trial was registered in the U.S. National Library of Medicine Clinical Trials Registry (registration number: NCT05238506; date of first registration: 14 February 2022).