The Utilization of an Opioid-Free Anesthetic for Pediatric Circumcision in an Ambulatory Surgery Center

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.

Efficacy of Dexmedetomidine Anesthesia plus Dorsal Penile Nerve Block in Pediatric Circumcision

“…The reason may be that dexmedetomidine-assisted anesthesia reduces the stress-induced neuroendocrine response, stabilizes the child's hemodynamics, and reduces adverse effects and perioperative myocardial ischemia, thereby providing favorable conditions for the uneventful implementation of intraoperative and postoperative examinations and treatments. It has been shown [ 20 ] that the application of dexmedetomidine before induction of anesthesia provided stable hemodynamics, alleviated postoperative pain, and reduced the occurrence of agitation in children during the awakening period. Moreover, the results of the present study showed that the combined anesthesia resulted in a significantly lower incidence of complications and a high parent satisfaction versus total anesthesia ( P > 0.05), which was consistent with the results of previous research.…”

The Effect of Computer Tablets on the Need for Medical Anxiolysis in Children in an Ambulatory Surgical Center

“…Studies have shown that handheld video games, DVD players, cartoons, music, virtual reality, and even video glasses significantly reduce levels of anxiety in children preparing to undergo surgery [6,[10][11][12]. In particular, when tablet-based distraction was compared to midazolam, improvements were seen in emergence delirium and length of stay, in addition to preoperative anxiety [13].…”

Urology in Pediatrics

“…Laura E. Gilberston and colleagues reported a study on the utilization of an opioid-free anesthetic for circumcision in an ambulatory surgery center. They reported a substantial decrease in in-room and postoperative recovery time with the utilization of this anesthetic approach [6]. Varicocele is a frequent pathology in adolescents, and laparoscopic varicocelectomy has gained growing popularity among pediatric surgeons.…”