Fewer opioids lead to fewer pain-related visits after T+A

Fewer opioids lead to fewer pain-related visits after T+A | | Image Credit: Contemporary Pediatrics

Following a FDA black box warning against prescribing opioids after tonsillectomy with adenoidectomy (T+A), opioid prescriptions indeed fell in this population and so did pain-related return visit rates. At the same time, prescriptions for steroids increased among youngsters undergoing T+A.

These were the findings of a retrospective cohort study in 4,778 patients with a median age of 5 years who underwent T+A in a 3-year period during which the FDA issued its warning. After surgery, 677 patients made return visits related to pain. Opioids (without steroids) were prescribed to 44.6% of patients, steroids (without opioids) to 34.4%, and both opioids and steroids to 16.8%. Patients who received opioids were more likely to make return visits than those who did not: 17% vs. 13.7%. Return visits specifically related to pain also were more common (14.7%) among those who received opioids than among those who did not (11.4%), while admission rates at revisit were similar for those who received opioids and those who did not (31.6% vs 28.5%).

THOUGHTS FROM DR. FARBER:

This study, done after the 2013 release of the black box warning against codeine use after a T+A, shows that opioid use actually increased the likelihood of follow-up pain visits. I suspect that some doctors still have not changed their ways, so if you see your ENT, EM, or pediatric colleagues prescribing them, please ask them to stop.

Reference:

Cohen N, Schissler K, Jeter J, Stathas A, Lozano J, Dave S, Lowe D. Change in pediatric adenotonsillectomy postoperative visit patterns after opioid Food and Drug Administration warning. Pediatr Emer Care. 2024;40:38-44. Doi:10.1097/PEC.0000000000002926.