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MP17-18 A PIPE DREAM? OPIOID-FREE ANESTHESIA IN PEDIATRIC UROLOGY

INTRODUCTION AND OBJECTIVE: Historically, intraoperative opioid use has been routine in the care of pediatric surgical patients. However, this is often associated with prolonged recovery times, postoperative nausea and vomiting (PONV), constipation, and pruritus. In an effort to reduce postoperative complications, Seattle Children's Hospital (SCH) has eliminated intraoperative opioid administration for outpatient pediatric urologic surgeries. We aimed to investigate differences in outcomes after transitioning to an opioid-free multimodal analgesia regimen. METHODS: Patients who underwent outpatient urologic procedures at SCH from 2015-2021 were stratified based on administration of intraoperative opioids. In 2018, we transitioned from opioid use in favor of multimodal methods including dexmedetomidine and regional anesthesia. Outcome metrics included recovery length of stay, postoperative pain scores, need for postoperative PONV treatment, and readmission rates. RESULTS: 2,845 patients were included in our study, of whom 1,795 received no intraoperative opioids (Table 1). In the postintervention group, 98% of pediatric urology surgeries were conducted opioid-free (Figure 1). Postoperative pain scores in the postintervention group were non-inferior to those of the opioid group (2.28 vs. 2.19, respectively). Length of stay in the recovery room was also not significantly different between the two groups (67.3 vs. 62.9 minutes). No differences were seen in rates of 7-day readmission. There was a 74% reduction in PONV as compared to the preintervention opioid group, leading to increased family satisfaction scores. CONCLUSIONS: By increasing use of non-opioid medications and regional anesthesia techniques, opioid-free anesthesia for outpatient pediatric urologic surgeries is readily achievable. We demonstrated a decrease in opioid-related side effects with no increase in pain scores, recovery length of stay or readmission rates. Source of Funding: none