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
Informational
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
  • 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
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
  • Injection of local anesthetic is not considered for this measure. Systemic lidocaine administered via IV infusion is considered as an alternative to regional anesthesia techniques.
  • Intramuscular route only valid if used for Ketorolac
  • To minimize false positives, Dexamethasone given alone is not considered a non-opioid adjunct for this measure.

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.

Scenario

Non-Opioid Adjunct (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

Not applicable - Departmental Only

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

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

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.