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To examine whether a service guideline reducing postoperative opioid prescription quantities and caregiver-reported education to use nonopioid analgesics first are associated with caregiver-reported pain control after pediatric tonsillectomy.Prospective cohort study (July 2018-April 2019).Pediatric otolaryngology service at a tertiary academic children's hospital.Caregivers of patients aged 1 to 11 years undergoing tonsillectomy (N = 764) were surveyed 7 to 21 days after surgery regarding pain control, education to use nonopioid analgesics first, and opioid use. Respondents who were not prescribed opioids or had missing data were excluded. Logistic regression modeled caregiver-reported pain control as a function of service guideline implementation (December 2018) recommending 20 rather than 30 doses for postoperative opioid prescriptions and caregiver-reported analgesic education, adjusting for patient demographics.Among 430 respondents (56% response), 387 patients were included. The sample was 43% female with a mean age of 5.0 years (SD, 2.5). Pain control was reported as good (226 respondents, 58%) or adequate/poor (161 respondents, 42%). Mean opioid prescription quantity was 27 doses (SD, 7.9) before and 21 doses (SD, 6.1) after guideline implementation (Caregiver education to use nonopioid analgesics first may be a modifiable health care practice to improve pain control as postoperative opioid prescription quantities are reduced.

This study aimed to assess whether caregiver-reported storage and disposal education were associated with locked opioid storage and disposal of leftover opioids after children's surgery.Caregivers of children18 years who were prescribed an opioid were surveyed 7-21 days after surgery at an academic children's hospital (4/1/2018-3/31/2019) on opioid-related education and management practices (54% response rate). Multivariable logistic regression models were estimated for locked storage and disposal of leftover opioids as functions of storage and disposal education, adjusting for demographics, procedure, prescription characteristics, and postoperative day at time of survey.Among 606 respondents, storage education was reported by 366 (60.4%) and locked storage by 111 caregivers (18.3%). Caregivers who reported verbal storage education (aOR 3.01 (95% CI 1.52-5.94); p = 0.001) or both written and verbal storage education (aOR 2.18 (95% CI 1.30-3.68); p = 0.003) were more likely to lock opioids in storage. Among 451 caregivers with leftover opioids, disposal education was reported by 226 (50.1%) and disposal by 111 caregivers (24.6%). There was no association between verbal and/or written disposal education with disposal.Caregivers infrequently reported education, locked storage, and disposal of leftover opioids after children's surgery. Education may improve locked opioid storage, but additional strategies are needed to increase disposal.Treatment.Level III.

This study investigates patient-reported opioid consumption after pediatric operations.