Pediatric Pain Optimization After Tonsillectomy

Pediatric Pain Optimization After Tonsillectomy: A Randomized Double Blind Methadone Pilot Study

The purpose of this study is to compare the use of short acting opioids (fentanyl/hydromorphone) with long acting opioids (methadone) for pain control following tonsillectomy surgery.

This is a single center, randomized, double blind, parallel-group dose escalation investigation which will compare post operative pain control indices for patients receiving short acting versus long acting opioids as intraoperative analgesics. Surgical and anesthesia care, except for intraoperative opioid management, are not altered for study purposes. Subjects are randomized 2:1 to either long-duration (methadone) or short-duration opioid (fentanyl, hydromorphone) through the perioperative period. Exploratory data will be collected for up to 30 days post-operatively.

Inclusion Criteria:

• Children ages 3 to 17 years old
• Presenting for elective tonsillectomy +/- adenoidectomy
• Provide informed consent / assent (as appropriate)

Exclusion Criteria:

• History of liver or kidney disease
• Females with positive pregnancy test
• Severe sleep apnea (Sleep study with Apnea Hypopnea Index (AHI) > 10)
• Consistent daily opioid use for chronic pain ( >3 months)