Measure Abbreviation
PAIN-01-Peds
Data Collection Method

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.

Measure Type
Process
Description

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

Measure Time Period

Preop Start to Anesthesia End

Inclusions

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

Exclusions
Success

At least one non-opioid adjunct (medication, regional block, caudal, or epidural) was administered to the patient during the preoperative or intraoperative period.

 

Other Measure Build Details

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 ConsiderationsDocumentation 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

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

Responsible Provider

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

Threshold
None
MPOG Concept IDs Required

 

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%

REGIONAL BLOCK

Value Code: 1-22

Peripheral Nerve Blocks

NEURAXIAL ANESTHESIA

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)

Rationale

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.

Risk Adjustment

Not Applicable

References
  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.