Opioids unnecessary for tonsillectomy pain relief

With a full-blown opioid epidemic making headlines, the push to use nonopioid medications to treat pain has been pervasive. However, a new study in JAMA Otolaryngology-Head & Neck Surgery indicates that children undergoing a tonsillectomy may be given opioid pain relief, going against current practice guidelines that recommend nonopioid relief.

Researchers used 2016 to 2017 claims data from a larger national private insurer in the United States. They looked for opioid-naïve children who were aged 1 to 18 years and had a claims code for tonsillectomy either with or without adenoidectomy between April 1, 2016 and December 15, 2017. After removing children who met the exclusion criteria, the sample included 15,793 children.

In the sample, the average age was 7.8 years and 81.1% of the sample were aged younger than 12 years.  A slight majority of 52.6% were female. They found that 9411 of the children had at least 1 perioperative medication fill, meaning a prescription drug claim for opioids between 7 days before to 1 day after the procedure, with a median prescription duration of 8 days. The rest of the sample had no perioperative medication fills. The probability of having a fill as well as the duration of the prescription was varied across US census divisions. The researchers found that having 1 or more perioperative medication fills was not linked with secondary hemorrhage (adjusted odds ratio [AOR], 0.90; 95% CI, 0.73-1.10) or having a return visit for pain or dehydration (AOR, 1.13; 95% CI, 0.95-1.34) when compared to children who had no opioid use. Perioperative fills were linked to increased risk of a return visit for constipation (AOR, 2.02; 95% CI, 1.24-3.28).

The researchers said that the findings indicate that reducing opioid prescriptions for tonsillectomies could be possible and not lead to a risk of complications such as a secondary hemorrhage or additional pain.