• Jian Guo, Peijun Zhuang, Kun Liu, Yuanyuan Wan, and Xuan Wang.
• Department of Anesthesia, Children's Hospital of Fudan University, 399 Wanyuan Road, Shanghai, 201102, China.
• BMC Anesthesiol. 2021 Feb 8; 21 (1): 41.

BackgroundIt has been proposed that the dose of rescue opioids should be individually titrated to the severity of obstructive sleep apnea after adenotonsillectomy. However, a sleep study is not always available before adenotonsillectomy. This randomized, controlled and blinded trial evaluated a strategy of pain control individualized to the results of a fentanyl test, rather than the results of polysomnography, in children after adenotonsillectomy.MethodsA total of 280 children (3-10 years old) undergoing elective adenotonsillectomy were randomized into an individualized protocol (IP) group or a conservative protocol (CP) group. All patients received a fentanyl test before extubation. Pain was assessed every 10 min in the recovery room, and rescue morphine was given when the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) score was > 6. In the IP group, the dose of rescue morphine was individualized to the results of the fentanyl test (10 μg/kg in the case of a positive result and 50 μg/kg in the case of a negative result). In the CP group, the dose was fixed (25 μg/kg). The primary outcome was the percentage of patients requiring at least one medical intervention. The secondary outcome was the median duration of CHEOPS scores > 6.ResultsFewer patients in the IP group than in the CP group required medical interventions [11.9% (16/134) vs 22.3% (29/130), P = 0.025]. The median duration of CHEOPS scores > 6 was shorter in the IP group than in the CP group [20 (95% CI: 17 to 23) min vs 30 (95% CI: 28 to 32) min, P <  0.001].ConclusionsCompared with a conservative dosing approach, this individualized protocol may improve analgesia without a significant increase in respiratory adverse events.Trial RegistrationClinicalTrials.gov NCT02990910 , registered on 13/12/2016.

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