COMPARISON OF POSTOPERATIVE EMESIS, RECOVERY PROFILE, AND ANALGESIA IN PEDIATRIC STRABISMUS REPAIR - RECTAL ACETAMINOPHEN VERSUS INTRAVENOUS FENTANYL-DROPERIDOL

Background: Postoperative nausea and vomiting comprise significant mor bidity in pediatric patients undergoing strabismus repair and can prol ong hospitalization. Many authors recommend routine intraoperative opi ate analgesia and prophylactic antiemetics, Methods: A prospective, co mparative, randomized study to assess rectal acetaminophen (n = 45) to intravenous fentanyl-droperidol (n = 45) to resolve recovery profile, emesis rate, and adequacy of analgesia in a pediatric strabismus repa ir population was performed, with standardization of the anesthetic te chnique. Data on pharmacoeconomic cost-effectiveness analysis, willing ness to pay, and willingness to repeat were elucidated. Results: Emesi s rate in the acetaminophen group was 9%, and the fentanyl-droperidol group was 13% (not statistically significant). There was a statistical ly significant shorter wake-up time, time in postanesthesia recovery, time in ambulatory surgery unit, time to first verbal command, time to first oral intake, time to ambulation, and time to return to normal a ctivity in the acetaminophen group (P < 0.05). Postoperative analgesic potency of rectal acetaminophen was adequate and equivalent by Observ er Pain Scare. Parental satisfaction was similar by willingness-to-pay and willingness-to-repeat postoperative survey. Cost-effectiveness ra tio (i.e., cost per treatment success) for acetaminophen and fentanyl- droperidol groups was $0.33 and $87.91, respectively. Conclusions: Pro phylactic fentanyl-droperidol prolongs the length-of-stay and recovery time and provides no discrete identifiable benefit over acetaminophen alone in this population. Cost-effectiveness analysis strongly favors use of acetaminophen over fentanyl-droperidol prophylaxis in children undergoing primary strabismus surgery.