The opioid crisis has strengthened focused efforts on addressing the impact of opioids in the pediatric population. Research continues to support multimodal analgesia in the perioperative period with validated opioid-sparing perioperative protocols, including Enhanced Recovery After Surgery (ERAS) expanding into the pediatric space and gaining momentum (Pediatr Surg Int 2019;35:631-4).

We recognize that opioid-free treatment is not always appropriate, especially after major surgery where opioids are a necessary tool, and therefore don't ascribe to the movement to eliminate opioids from anesthesia and analgesia altogether.

Many organizations have provided valuable recommendations for the use of opioids for postoperative patients, including the Society for Pediatric Anesthesia, the Centers for Disease Control and Prevention, and the Substance Abuse and Mental Health Services Administration (Paediatr Anaesth 2019;29:547-71;; MMWR Recomm Rep 2016;65:1-49). Guidance and recommendations in children...

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