This measure is calculated based on data extracted from the electronic medical record combined with administrative data sources such as professional fee and discharge diagnoses data. This measure is explicitly not based on provider self-attestation.
Percentage of patients < 18 years old who undergo a surgical or therapeutic procedure and receive a non-opioid adjunct preoperatively or intraoperatively.
Preop Start to Anesthesia End
Patients < 18 years old who undergo any procedure including surgical, therapeutic, or diagnostic requiring care by anesthesia providers.
At least one non-opioid adjunct (medication, regional block, caudal, or epidural) was administered to the patient during the preoperative or intraoperative period.
Dexamethasone given alone is not considered a non-opioid adjunct to prevent multiple false positives that may skew measure performance.
Opioid Sparing Medications must be administered between Preop Start and Anesthesia End via a valid route (see MPOG route concepts listed above). Systemic lidocaine administered via IV infusion is considered as an alternative to regional anesthesia techniques.
Local Anesthetic Considerations: Documentation must occur between Anesthesia Start and Anesthesia End
Algorithm for determining patients who remained intubated postoperatively:
Scenario |
Non-Opioid (Medication) |
Neuraxial (Caudal, Epidural, Spinal) |
Regional Block |
Case Attribute |
Result |
A |
Yes |
Yes |
Yes |
INCLUDE |
PASS |
B |
Yes |
Yes |
No |
INCLUDE |
PASS |
C |
Yes |
No |
No |
INCLUDE |
PASS |
D |
No |
No |
No |
INCLUDE |
FLAG |
E |
No |
No |
Yes |
INCLUDE |
PASS |
F |
No |
Spinal/CSE/Unknown |
No |
EXCLUDE |
----- |
F2 |
No |
Caudal |
No |
INCLUDE |
PASS |
F3 |
No |
Epidural |
No |
INCLUDE |
PASS |
F4 |
No |
Neuraxial-Multiple |
No |
INCLUDE |
PASS |
G |
No |
Yes |
Yes |
INCLUDE |
PASS |
Any provider signed into the case between Anesthesia Start and Anesthesia End
MPOG Concept ID |
Concept Description |
Route |
|
2001 |
Intravenous |
2003 |
Intramuscular (*Ketorolac only) |
2008 |
Oral |
2009 |
Nasal |
2023 |
Enteric Tube |
2012 |
Rectal |
LOCAL ANESTHETIC | |
2007 |
Local Infiltration (route) |
2027 |
Intradermal (must contain text ‘-caine’) |
50626 |
Misc - Local Infiltration of surgical site by surgical team |
ACETAMINOPHEN |
|
10007 |
Acetaminophen |
10009 |
Acetaminophen / Butalbital / Caffeine |
10041 |
Aspirin / Acetaminophen / Caffeine |
NSAIDS |
|
10040 |
Aspirin |
10222 |
Ibuprofen |
10747 |
Naproxen |
10116 |
Celecoxib |
KETOROLAC |
|
10239 |
Ketorolac |
KETAMINE |
|
10238 |
Ketamine |
10453 |
PROPOFOL W/ KETAMINE 10 MG/ML + 1 MG/ML |
10572 |
PROPOFOL W/ KETAMINE 10MG/ML + UNSPECIFIED KETAMINE |
10577 |
PROPOFOL W/ KETAMINE 10 MG/ML + 0.5 MG/ML |
10578 |
PROPOFOL W/ KETAMINE 10 MG/ML + 1.5 MG/ML |
10579 |
PROPOFOL W/ KETAMINE 10 MG/ML + 2 MG/ML |
OTHER |
|
10149 |
Dexmedetomidine |
10199 |
Gabapentin |
10570 |
Pregabalin |
10132 |
Clonidine |
10180 |
Esmolol (*Infusion only) |
10705 |
Magnesium |
LIDOCAINE (IV Infusion only) |
|
10477 |
LIDOCAINE |
10589 |
LIDOCAINE 0.4% |
10247 |
LIDOCAINE 0.5% |
10248 |
LIDOCAINE 1% |
10249 |
LIDOCAINE 1.5% |
10250 |
LIDOCAINE 2% |
10691 |
LIDOCAINE 2% W/ BICARBONATE |
10251 |
LIDOCAINE 3% |
10252 |
LIDOCAINE 4% |
Value Code: 1-22 |
Peripheral Nerve Blocks |
Value Code: 4 |
Caudal |
Value Code: 2 |
Epidural |
Value Code: 6 |
Neuraxial - Multiple Types Listed |
Value Code: 1,3,5 |
Spinal, Combined Spinal/Epidural, Neuraxial - Unknown |
PACU PAIN SCORE |
|
3086 |
Pain Score (Generic) |
3087 |
Pain Score (FLACC) |
3088 |
Pain Score (Visual Analog Scale) |
3089 |
Pain Score (Faces) |
Multimodal pain management in children during the perioperative time frame can decrease postoperative pain, improve clinical outcomes, and patient satisfaction after surgery. Opioids hold a prominent role in acute pain management yet carry significant risk of perioperative complications including postoperative nausea and vomiting (PONV), respiratory depression, and increased recovery time after surgery. The American Society of Anesthesiologists (ASA) and Society for Pediatric Anesthesia (SPA) have published guidelines and recommendations which endorse the routine use of multimodal analgesia whenever possible to reduce opioid administration and its side effects. Current evidence supports the use of opioid sparing analgesics in pediatric surgical populations that act through different mechanisms. This list includes (but is not limited to) acetaminophen, NSAIDs, dexamethasone, ketamine, clonidine, and dexmedetomidine.
Not Applicable