Abstract
Circumcision is one of the most common urologic procedures performed at pediatric ambulatory centers. Emerging data on the short- and long-term effects of perioperative opioid administration has highlighted the importance of an opioid-free anesthetic regimen. We sought to evaluate the effectiveness of an opioid-free anesthetic in pediatric circumcision and its correlation with ambulatory surgery center efficiency. Patients, 3 years of age and younger, who underwent circumcision or circumcision revision by two surgeons pre and post introduction of an opioid-free anesthetic fast-track regimen at an outpatient surgical center were included. There were 100 patients included in this analysis, with 50 patients in each cohort. On univariate analysis, fast-tracking was associated with a decrease in median combined in-room and post-anesthesia care unit times (102.5 vs. 129.0 min, p-value < 0.001). This difference continued after multivariable analysis with an adjusted median combined in-room and post-anesthesia care unit time difference of −15.6 min (95% CI −34.2 to −12.7 min, p-value 0.018). In addition, the fast-track cohort received less intraoperative morphine equivalents without an increase in post-operative analgesic administration or change in postoperative questionnaire score. This demonstrates that opioid-free anesthesia may be used effectively in pediatric circumcision while also allowing for significant time savings for surgical centers.
Highlights
Circumcision is one of the most commonly performed urologic procedures in pediatrics
Fast tracking was associated with a decrease in median combined in-room and post-anesthesia care unit (PACU) times (102.5 vs. 129.0 min, p-value < 0.001, Table 3 and Figure 1)
This difference continued after multivariable analysis with an adjusted median combined in-room and PACU time difference of −15.6 min
Summary
Circumcision is one of the most commonly performed urologic procedures in pediatrics. There remains large variability in anesthetic and analgesic techniques for this relatively quick procedure. Most perioperative techniques involve the use of opioids in combination with regional as well as general anesthesia. The national opioid epidemic has shed light on the role anesthesiologists and perioperative opioid administration are contributing to this crisis [1,2]. It has been recognized that perioperative opioid use is a risk factor for future opioid misuse [3]. Newer data highlights the increasing trend in opioid dependence among children [4]
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