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.

• Patients ≥ 18 years of age
• ASA 5 and 6
• Cardiac Surgery (CPT: 00560, 00561, 00562, 00563, 00566, 00567, 00580)
• Obstetric Procedures
• Radiology Procedures
  • Anesthesia for non-invasive imaging or radiation therapy (CPT: 01922)
  • Has following MRI keywords in procedure text:
    • MRI, MR Head, MR Brain, MR Chest, MR Torso, MR Abdomen, MR Lumbar, MR Spine, MR Knee, MR Femur, MR Abd, Offsite radiology procedure
  • Rooms tagged as: ‘Radiology - MRI’ or ‘Radiology - interventional radiology’
• Non-operative procedures 
  • (CPT: 00104, 00124, 00532, 00635, 00731, 00732, 00740, 00810, 00811, 00812, 00813, 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.

• Local anesthetic is captured through medications documented with a route mapped to ‘Local infiltration’ or ‘intradermal’ with medication text including %caine%. Intraop notes mapped to ‘Misc - Local Infiltration of surgical site by surgical team’ are also considered.
• Systemic lidocaine administered via IV infusion is considered as an alternative to regional anesthesia techniques.
• Intramuscular route only valid if used for Ketorolac
• Dexamethasone given alone is not considered a non-opioid adjunct for this measure, because of use for PONV prophylaxis

Algorithm for determining patients who remained intubated postoperatively:

1. Was the patient transported to PACU? If Yes, Include.  If No, then 
2. Was ExtubationTime prior to Anesthesia End? If Yes, Include. If No or missing, then,
3. Was ‘Emergence - ETT in place, patient manually ventilated’ (ID 50380) documented between procedure end and anesthesia end? If no, Include. If Yes, exclude.

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

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

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.