Reducing Postoperative Pain in Pediatric Tonsillectomies with Opioid Alternatives

Strategic Insights -

Research conducted by the Hospital for Sick Children in Toronto, Canada, aimed to reduce moderate to severe postoperative pain in children undergoing tonsillectomies by 50% within 12 months. The study involved collecting pilot data on intraoperative care and postanesthesia care unit (PACU) pain outcomes from June 2018 to June 2020 and implementing a six-item toolkit to improve pain management. The results showed a significant reduction in postoperative pain without increasing the risk of postoperative respiratory adverse events (PRAEs), postoperative nausea/vomiting incidence, or PACU length of stay.

Key Takeaways:

  • The study aimed to reduce moderate to severe postoperative pain in pediatric tonsillectomies by 50% within 12 months.
  • Pilot data was collected on intraoperative care and PACU pain outcomes of patients between June 2018 and June 2020.
  • A six-item toolkit was designed and implemented to improve pain management, consisting of guidelines for intraoperative opioid use, postoperative pain management, and patient education.
  • Postintervention patients were categorized into three groups: Standard of Care, Partial Compliance, and Full Compliance. Patients who fully complied with the toolkit had a significant reduction in moderate to severe postoperative pain.
  • The study concluded that the improvements were achieved without increasing PRAEs, postoperative nausea/vomiting incidence, or PACU length of stay.
  • The study was conducted by a team of researchers from the Hospital for Sick Children, led by Lara Navarro, with additional authors including Alfonso Ernesto Albornoz, Julia Mallen, Sophie O'Halloran, Simon Denning, Clyde Matava, Sharon L. Cushing, Nikolaus E. Wolter, Conor Mc Donnell, and Maisie Tsang.
  • The research was featured in the journal Pediatric Anesthesia and was peer-reviewed.

Statistics:

  • 50% reduction in moderate to severe postoperative pain aimed by the study.
  • 2018-2020: Pilot data collection period for intraoperative care and PACU pain outcomes.
  • 2021: Implementation of the six-item toolkit to improve pain management.
  • 12 months: Targeted timeframe for achieving the 50% reduction in postoperative pain.
  • 50-75% reduction in moderate to severe postoperative pain achieved by patients who fully complied with the toolkit.
  • No increase in PRAEs, postoperative nausea/vomiting incidence, or PACU length of stay observed in the study.

Sources:

  • "A Quality Improvement Initiative to Improve Early Postoperative Pain Outcomes After Tonsillectomy in Children." Pediatric Anesthesia, 2025.
  • NewsRx. "Researchers' Work from Hospital for Sick Children Focuses on Opioids (A Quality Improvement Initiative to Improve Early Postoperative Pain Outcomes After Tonsillectomy in Children)." Pediatrics Week. October 25, 2025; p 1947.