{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T20:49:24Z","timestamp":1790023764737,"version":"4.0.1"},"reference-count":64,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2023,6,10]],"date-time":"2023-06-10T00:00:00Z","timestamp":1686355200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2023,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Opioid use is common and associated with side effects and risks. Consequently, analgesic strategies to reduce opioid utilization have been developed. Regional anesthesia and multimodal strategies are central tenets of enhanced recovery pathways and facilitate reduced perioperative opioid use. Opioid\u2010free anesthesia (OFA) protocols eliminate all intraoperative opioids, reserving opioids for postoperative rescue treatment. Systematic reviews show variable results for OFA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In a series of Quality Improvement (QI) projects, multidisciplinary teams developed interventions to test and spread OFA first in our ambulatory surgery center (ASC) and then in our hospital. Outcome measures were tracked using statistical process control charts to increase the adoption of OFA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Between January 1, 2016, and September 30, 2022, 19\u2009872 of 28\u2009574 ASC patients received OFA, increasing from 30% to 98%. Post Anesthesia Care Unit (PACU) maximum pain score, opioid\u2010rescue rate, and postoperative nausea and vomiting (PONV) treatment all decreased concomitantly. The use of OFA now represents our ambulatory standard practice. Over the same timeframe, the spread of this practice to our hospital led to 21\u2009388 of 64\u2009859 patients undergoing select procedures with OFA, increasing from 15% to 60%. Opioid rescue rate and PONV treatment in PACU decreased while hospital maximum pain scores and length of stay were stable. Two procedural examples with OFA benefits were identified. The use of OFA allowed relaxation of adenotonsillectomy admission criteria, resulting in 52 hospital patient days saved. Transition to OFA for laparoscopic appendectomy occurred concomitantly with a decrease in the mean hospital length of stay from 2.9 to 1.4\u2009days, representing a savings of &gt;500 hospital patient days\/year.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>These QI projects demonstrated that most pediatric ambulatory and select inpatient surgeries are amenable to OFA techniques which may reduce PONV without worsening pain.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.14705","type":"journal-article","created":{"date-parts":[[2023,6,10]],"date-time":"2023-06-10T07:19:26Z","timestamp":1686381566000},"page":"699-709","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Outcomes for 41\u2009260 pediatric surgical patients with <scp>opioid\u2010free<\/scp> anesthesia: One center's experience"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9513-8763","authenticated-orcid":false,"given":"Lynn D.","family":"Martin","sequence":"first","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine and Pediatrics Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6334-0916","authenticated-orcid":false,"given":"Amber M.","family":"Franz","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4789-4235","authenticated-orcid":false,"given":"Sally E.","family":"Rampersad","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9937-8577","authenticated-orcid":false,"given":"Bukola","family":"Ojo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel K.","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7792-5269","authenticated-orcid":false,"given":"Lizabeth D.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1266-7382","authenticated-orcid":false,"given":"Agnes I.","family":"Hunyady","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean H.","family":"Flack","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy M.","family":"Geiduschek","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology &amp; Pain Medicine Seattle Children's Hospital\/University of Washington School of Medicine  Seattle Washington USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,6,10]]},"reference":[{"key":"e_1_2_13_2_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003668"},{"key":"e_1_2_13_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000542-1990100000-00012"},{"key":"e_1_2_13_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/bja.2019.02.018"},{"key":"e_1_2_13_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j\/bja.2017.05.003"},{"key":"e_1_2_13_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACO.0000000000000485"},{"key":"e_1_2_13_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu137"},{"key":"e_1_2_13_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(19)30430-1"},{"key":"e_1_2_13_9_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2017.0504"},{"key":"e_1_2_13_10_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004823"},{"key":"e_1_2_13_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40122-018-0097-6"},{"key":"e_1_2_13_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10071472"},{"key":"e_1_2_13_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13225"},{"key":"e_1_2_13_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13741-018-0097-4"},{"key":"e_1_2_13_15_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004109"},{"key":"e_1_2_13_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000001012"},{"key":"e_1_2_13_17_1","first-page":"152","article-title":"The benefits of opioid free anesthesia and the precautions necessary when employing it","volume":"7","author":"Bohringer C","year":"2020","journal-title":"Transl Perioper Pain Med"},{"key":"e_1_2_13_18_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004194"},{"key":"e_1_2_13_19_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000006256"},{"key":"e_1_2_13_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anclin.2017.01.006"},{"key":"e_1_2_13_21_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aev226"},{"key":"e_1_2_13_22_1","doi-asserted-by":"publisher","DOI":"10.4103\/0970-9185.168149"},{"key":"e_1_2_13_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1399-6576.205.00814.x"},{"key":"e_1_2_13_24_1","doi-asserted-by":"publisher","DOI":"10.1111\/anae.14582"},{"key":"e_1_2_13_25_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm10102069"},{"key":"e_1_2_13_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/aas.13994"},{"key":"e_1_2_13_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000003572"},{"key":"e_1_2_13_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/ALN.0000000000004065"},{"key":"e_1_2_13_29_1","volume-title":"The Health Care Data Guide: Learning from Data for Improvement","author":"Provost L","year":"2011"},{"key":"e_1_2_13_30_1","first-page":"293","article-title":"The FLACC: a behavioral scale for scoring postoperative pain in young children","volume":"23","author":"Merkel SI","year":"1997","journal-title":"Pediatr Nurs"},{"key":"e_1_2_13_31_1","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsm103"},{"key":"e_1_2_13_32_1","doi-asserted-by":"publisher","DOI":"10.1016\/0952-8180(94)00001-k"},{"key":"e_1_2_13_33_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0b013e3181e33429"},{"key":"e_1_2_13_34_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD003591.pub3"},{"key":"e_1_2_13_35_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.24555"},{"key":"e_1_2_13_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.13662"},{"key":"e_1_2_13_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000462"},{"key":"e_1_2_13_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/pq9.0000000000000548"},{"key":"e_1_2_13_39_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004774"},{"key":"e_1_2_13_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2017.09.008"},{"key":"e_1_2_13_41_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000539-199909000-00022"},{"key":"e_1_2_13_42_1","doi-asserted-by":"publisher","DOI":"10.5664\/jcsm.8118"},{"key":"e_1_2_13_43_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2022.8679"},{"key":"e_1_2_13_44_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoto.2022.1803"},{"key":"e_1_2_13_45_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599811409837"},{"key":"e_1_2_13_46_1","doi-asserted-by":"publisher","DOI":"10.1177\/0194599818807917"},{"key":"e_1_2_13_47_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijorl.2020.110276"},{"key":"e_1_2_13_48_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.sempedsurg.2018.02.005"},{"key":"e_1_2_13_49_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpedsurg.2021.04.004"},{"key":"e_1_2_13_50_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00383-021-05008-8"},{"key":"e_1_2_13_51_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000002510"},{"key":"e_1_2_13_52_1","unstructured":"Accessed January 12 2023.https:\/\/www.qualityhealth.org\/bree\/wp\u2010content\/uploads\/sites\/8\/2018\/11\/FY19\u2010217\u2010Summary\u2010of\u2010opioid\u2010prescribing\u2010practices\u2010for\u2010perioperative\u2010pain.pdf"},{"key":"e_1_2_13_53_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamasurg.2020.5045"},{"key":"e_1_2_13_54_1","doi-asserted-by":"publisher","DOI":"10.1504\/IJHTM.2008.016849"},{"key":"e_1_2_13_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.14423"},{"key":"e_1_2_13_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/pan.12383"},{"key":"e_1_2_13_57_1","doi-asserted-by":"publisher","DOI":"10.1177\/0003489415583685"},{"key":"e_1_2_13_58_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-1906"},{"key":"e_1_2_13_59_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.98.2.294"},{"key":"e_1_2_13_60_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-27.4.347"},{"key":"e_1_2_13_61_1","doi-asserted-by":"publisher","DOI":"10.5863\/1551-6776-26.3.240"},{"key":"e_1_2_13_62_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40272-022-00514-1"},{"key":"e_1_2_13_63_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000003977"},{"key":"e_1_2_13_64_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjqs-2014-003756"},{"key":"e_1_2_13_65_1","doi-asserted-by":"publisher","DOI":"10.1213\/ANE.0000000000004153"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.14705","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,17]],"date-time":"2023-08-17T19:15:41Z","timestamp":1692299741000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.14705"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,6,10]]},"references-count":64,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2023,9]]}},"alternative-id":["10.1111\/pan.14705"],"URL":"https:\/\/doi.org\/10.1111\/pan.14705","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,6,10]]},"assertion":[{"value":"2023-01-16","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-05-25","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-06-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}