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.
At least one non-opioid adjunct (medication, local, 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 |
Not Applicable
Any provider signed into the case between Anesthesia Start and Anesthesia End
Route
LOCAL ANESTHETIC
ACETAMINOPHEN
NSAIDS
KETOROLAC
KETAMINE
OTHER
LIDOCAINE (IV Infusion only)
REGIONAL BLOCK
NEURAXIAL ANESTHESIA
PACU PAIN SCORE
Measure Author | Institution |
---|---|
Bishr Haydar, MD | University of Michigan |
Meridith Wade, MSN, RN | University of Michigan |
Rob Coleman | University of Michigan |
MPOG Pediatric Subcommittee |
Date Reviewed | Reviewer | Institution | Summary | QC Vote |
---|---|---|---|---|
First Review: 12/2023 |
Date | Criteria | Revision |
---|---|---|
07/24/2023 | Exclusion | Updated radiology procedure exclusion to use new Diagnostic Imaging Procedures phenotype |
04/19/2023 | Exclusion | Bronchoscopy Procedures |
03/16/2023 | Exclusion | Replaced Non-Operative phenotype with Intubation Only as exclusion |
10/12/2022 | Exclusion | Modified to use TEE/Cardioversion and Endoscopy |
04/07/2022 | Success | Modified local anesthetic to check 10516 (other-local infiltration medication) |
02/11/2022 | Multiple | Exclude 'Other' Cardiac cases; Removed 1mL medication volumne check |
01/17/2022 | Exclusion | Modified to use new Cardiac phenotype to exclude open cardiac cases |
09/20/2021 | Exclusion | Modified to use new ECT phenotype |