Postoperative pain following pediatric tonsillectomy remains a significant clinical challenge. Inadequate management leads to delayed recovery, dehydration, and increased healthcare utilization. Multimodal analgesia, including combining systemic analgesics, local anesthetic techniques, and adjunctive medications, has emerged as the standard of care. This review highlights current perioperative pain management strategies, including recent evidence on multimodal and opioid-sparing approaches. Local infiltration and nerve blocks provide site-specific pain relief, reducing opioid requirements and improving patient comfort. A comprehensive understanding and careful selection of analgesic regimens are crucial for enhancing outcomes in this population.

Postoperative pain following pediatric tonsillectomy remains a significant clinical challenge. Inadequate management leads to delayed recovery, dehydration, and in-creased healthcare utilization. Multimodal analgesia, including combining systemic analgesics, local anesthetic techniques, and adjunctive medications, has emerged as the standard of care. This review highlights current perioperative pain management strategies, evaluates the role of methadone as an alternative opioid, and explores future directions in optimizing analgesia for pediatric patients undergoing tonsillectomy procedures. Local infiltration and nerve blocks provide site-specific pain relief, reducing opioid requirements and improving patient comfort. A comprehensive understanding and careful selection of analgesic regimens are crucial for enhancing outcomes in this population.

Background/Objectives: Continuous epidural analgesia is desirable for improving infant outcomes after surgeries. However, its contribution to facilitating extubation is not well known. Methods: A retrospective chart review was conducted at the UPMC Children’s Hospital of Pittsburgh to identify all infants who received an epidural catheter between 2018 and 2024 and required postsurgical admission to the Neonatal Intensive Care Unit (NICU). The study examined the timing of extubation and reintubation, along with associated factors, in 100 infants who underwent major surgeries. Results: In total, 100 infants, 43 females and 57 males, 40 (38.39–42.07) weeks corrected gestational age, 3 (2.52–3.42) kg received epidural catheters. Sixty-two patients had a pulmonary condition. Of 45 infants extubated in the operating room, 32 received fentanyl intraoperatively, and 16 required a morphine infusion in the NICU. Among 55 infants that remained intubated, 24% underwent a thoracic procedure, 46 received intraoperatively fentanyl, and 21 needed an opioid infusion postoperatively. The extubation day was median (IQR) 2 (1–4), and 24% remained intubated beyond day 5. Twelve infants were intubated preoperatively, and six required prolonged ventilation beyond day 5. Of 15 infants that required reintubation, 8 received a morphine infusion. The medians (IQR) of the average of three pain and sedation scores before reintubation were 1.67 (1–3) and 0 (−1.67–0), respectively. Conclusions: Epidural analgesia may facilitate early extubation in some infants undergoing surgeries. Morphine infusion was administered at a similar rate between infants extubated and those who remained intubated, and its role in delaying extubation timing remains unclear.