"Opioid-Free Hernia Repair Protocol Reduces Pediatric Opioid Exposure Without Compromising Pain Control".

PURPOSE: Protocolizing perioperative pain management may reduce opioid exposure in children. We designed a multimodal pain management protocol for pediatric ambulatory hernia surgery to reduce opioid use and studied its impact. METHODS: Our protocol utilized child life services, regional anesthesia, and non-opioid analgesics in the perioperative period. We reviewed all pediatric ambulatory hernia cases two years before and after protocol implementation. Protocol adherence was stratified by level of opioid use: high (no opioid use), medium (opioids one phase of care), and low adherence (opioids multiple phases of care). Post-operative surveys were used to measure satisfaction and pain control. RESULTS: 721 cases were reviewed with 356 pre-implementation and 365 post-implementation. Following protocol implementation, there was a significant increase of regional anesthesia (6.2% to 44.1%, p<.0001) and non-opioid analgesics intraoperatively (34.5% to 95.3%, p<.0001). This was accompanied by a significant decrease in intraoperative opioid use (86% to 8.2%, p<.0001) and postoperative opioid use (50.8% to 16.4%, p<.0001). Opioid prescriptions at discharge decreased from 11.5% to 1.9% (p <.0001). Maximum reported pain scores decreased (p<.001), as did minimum reported pain scores (p <.0001). Rates of postoperative complications were similar. 82.1% of patients/proxy reported satisfaction with pain control in the hospital and 76.1% with pain control at home. High protocol adherence was achieved in 77.3% of post-implementation cases. CONCLUSION: Our opioid-free pediatric hernia repair protocol significantly reduced perioperative opioid use, without compromising pain control, postoperative outcomes, or patient/proxy satisfaction, supporting the wider integration of opioid-free multimodal pain regimens in pediatric surgical care.