Percentage of patients < 18 years old who undergo a surgical or therapeutic procedure and receive a non-opioid adjunct preoperatively or intraoperatively.

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, ketamine, clonidine, and dexmedetomidine.

Preop Start to Anesthesia End

Patients < 18 years old who undergo any procedure including surgical, therapeutic, or diagnostic requiring care by anesthesia providers.

• Patients ≥ 18 years of age
• ASA 5 and 6
• Open Cardiac and 'other' cardiac procedures as determined by Procedure Type: Cardiac Surgery
• TEE/Cardioversions
• Endoscopy Procedures
• Obstetric Procedures
• Radiology Procedures
• Procedure Type: ECT 
• Intubation Only cases
• Otoscopy (00124)
• Central Line Placement (00532)
• Lumbar Puncture (00635)
• Other (01990, 01991, 01992, 01999)
  • Rooms tagged as ‘Other - offsite anesthesia’
  • Cases with procedure text ‘ABR Testing’ (without any additional procedures listed)
• Patients who remained intubated postoperatively (see ‘other measure build details’)
• Spinal, Combined Spinal/Epidural or Unknown Anesthesia Technique: Neuraxial

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 

• Captured through administration of medications with text including ‘-caine’ via medication routes NOT including
  • 2001  Intravenous 
  • 2034  Laryngotracheal
  • 2006  Inhalational
  • 2024  Endotracheal 
  • 2004  Intramuscular (Ketorolac only)
• Intraop notes mapped to ‘Misc - Local Infiltration of surgical site by surgical team’ (ID:50626) are also considered. 

Algorithm for determining patients who remained intubated postoperatively:

1. Was the patient transported to PACU? If Yes, Include.  If No, then 
2. Was extubation time prior to Anesthesia End? If Yes, Include. If No or missing, then,
3. Was MPOG concept 50380 ‘Emergence - ETT in place, patient manually ventilated’ documented between procedure end and anesthesia end? If Yes, exclude. If no, then,
4. Were sedation medication infusions continued after Anesthesia End? If Yes, exclude. If no, then include

Not Applicable

Any provider signed into the case between Anesthesia Start and Anesthesia End 

1. American Society of Anesthesiologists Task Force on Acute Pain Management. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-273.
2. Cravero JP, Agarwal R, Berde C, et al. The Society for Pediatric Anesthesia recommendations for the use of opioids in children during the perioperative period. Paediatr Anaesth. 2019;29(6):547-571.
3. Franz AM, Dahl JP, Huang H, et al. The development of an opioid sparing anesthesia protocol for pediatric ambulatory tonsillectomy and adenotonsillectomy surgery-A quality improvement project. Paediatr Anaesth. 2019;29(7):682-689.
4. Zhu A, Benzon HA, Anderson TA. Evidence for the Efficacy of Systemic Opioid-Sparing Analgesics in Pediatric Surgical Populations: A Systematic Review. Anesth Analg. 2017;125(5):1569-1587.