The Association of Preoperative Hydrocodone and Acetaminophen With Total Opioid Requirement, and Pain Experience in Children Undergoing Adenotonsillectomy.

Abstract

Pre-emptive analgesia may be of benefit in reducing total opioid use and improving the pain experience perioperatively. However, there is conflicting evidence as to the benefits of pre-emptive analgesia, with limited evidence in children. The aim of this study was to examine the association between preoperative use of hydrocodone with acetaminophen and total opioid consumption in children undergoing adenotonsillectomy. This was a retrospective cohort study of the children undergoing adenotonsillectomy surgery at Texas Children's Hospital between 11/2017 and 12/2018. Preoperative use of hydrocodone with acetaminophen was the exposure of interest. The primary outcome was total perioperative opioid consumption calculated as oral morphine equivalents (OME). Secondary outcomes of interest included: post-anesthesia care unit (PACU) pain experience and time to discharge. We used multivariable linear regression to estimate the association of hydrocodone with acetaminophen on the outcomes. A total of 1082 patients met inclusion criteria, 366 (33.8%) received pre-operative hydrocodone with acetaminophen. There was no difference in the total intraoperative and postoperative OME between groups, mean OME of 0.49 mg/kg (±0.23) in the HA group versus 0.50 mg/kg (±0.27) in the control group; p = 0.56. For PACU discharge, the median [IQR] for PACU discharge time was longer in the patients who did not receive preoperative HA, at 39.0 [25.0-58.0] versus 30.0 [20.0-46.0] min for the preoperative HA group. Use of preoperative HA was associated with a 61% likelihood of having a PACU discharge time exceeding 30 min, with an odds ratio (OR) of 0.39 (95% CI, 0.28, 0.54; p < 0.001). Use of preoperative HA resulted in a greater likelihood of exhibiting a maximal pain score of 0-3 in PACU, with an OR of 2.16 (95% CI, 1.56-2.99; p < 0.001), as well as an increased likelihood of a having a maximum recorded pain score of zero, with an OR of 1.85 (95% CI, 1.34-2.56; p < 0.001). Pre-operative hydrocodone with acetaminophen was associated with improved outcomes with respect to PACU pain experience and time to discharge. The total OME increase was limited to the pre-operative HA dose.