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Rudikoff AG, Tieu DD, Banzali FM, Nguyen CV, Rettig RL, Nashed MM, Mora-Marquez J, Chen Q, Conte AH, Mason KP. Perioperative Acetaminophen and Dexmedetomidine Eliminate Post-Operative Opioid Requirement following Pediatric Tonsillectomy. J Clin Med 2022; 11:jcm11030561. [PMID: 35160013 PMCID: PMC8836354 DOI: 10.3390/jcm11030561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/18/2022] [Accepted: 01/21/2022] [Indexed: 02/01/2023] Open
Abstract
Administration of post-operative opioids following pediatric tonsillectomy can elicit respiratory events in this patient population that often arise as central and obstructive sleep apnea. The primary objective of this study was to determine whether a perioperative combination of dexmedetomidine and acetaminophen could eliminate post-operative (in recovery and at home) opioid requirements. Following IRB approval and a waiver for informed consent, the medical records of 681 patients who underwent tonsillectomy between 1 January 2013 and 31 December 2018 were evaluated. Between 1 January 2013 and 31 December 2015, all patients received a fentanyl-sevoflurane-based anesthetic, without acetaminophen or dexmedetomidine, and received opioids in recovery and for discharge home. On 1 January 2016, an institution-wide practice change replaced this protocol with a multimodal perioperative regimen of acetaminophen (intravenous or enteral) and dexmedetomidine and eliminated post-operative opioids. This is the first time that the effect of an acetaminophen and dexmedetomidine combination on the perioperative and home opioid requirement has been reported. Primarily, we compared the need for rescue opioids in the post-anesthesia care period and after discharge. The multi-modal protocol eliminated the need for post-tonsillectomy opioid administration. Dexmedetomidine in combination with acetaminophen eliminated the need for post-operative opioids in the recovery period.
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Affiliation(s)
- Andrew G. Rudikoff
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA; (A.G.R.); (F.M.B.)
| | - David D. Tieu
- Department of Head & Neck Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA; (D.D.T.); (C.V.N.)
| | - Franklin M. Banzali
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA; (A.G.R.); (F.M.B.)
| | - Carolyn V. Nguyen
- Department of Head & Neck Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA; (D.D.T.); (C.V.N.)
| | - Robert L. Rettig
- Department of Surgery, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA;
| | - Marlene M. Nashed
- Department of Pharmacy, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA;
| | - Janet Mora-Marquez
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, Pasadena, CA 91101, USA; (J.M.-M.); (Q.C.)
| | - Qiaoling Chen
- Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S. Los Robles Avenue, Pasadena, CA 91101, USA; (J.M.-M.); (Q.C.)
| | - Antonio Hernandez Conte
- Department of Anesthesiology, Kaiser Permanente Los Angeles Medical Center, 4867 Sunset Blvd., Los Angeles, CA 90027, USA; (A.G.R.); (F.M.B.)
- Correspondence: ; Tel.: +1-323-573-3900
| | - Keira P. Mason
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA 02115, USA;
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Luo MS, Huang GJ. The efficacy of peritonsillar injection of bupivacaine vs intravenous acetaminophen on post-tonsillectomy pain in children. Eur Arch Otorhinolaryngol 2021; 279:5459-5461. [PMID: 34671857 DOI: 10.1007/s00405-021-07146-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Meng-Si Luo
- Department of Anesthesiology, Zhongshan Hospital of Traditional Chinese Medicine, Affiliated to Guangzhou University of Chinese Medicine, 3 Kangxin Road, Zhongshan, 528400, Guangdong, China
| | - Guan-Jiang Huang
- Department of Otorhinolaryngology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, 88 Jiefang Road, Hangzhou, 310009, Zhejiang, China.
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