Effectiveness of dexmedetomidine versus fentanyl on postoperative pain and recovery after pediatric tonsillectomy: A retrospective cohort study

Background: Pediatric tonsillectomy is commonly associated with significant postoperative pain. Opioids remain a mainstay for perioperative analgesia but carry risks of respiratory depression and prolonged recovery, especially in patients with obstructive sleep apnea (OSA). Dexmedetomidine, an alpha-2 adrenergic agonist, provides sedation and analgesia with minimal respiratory depression. Objective: To compare intraoperative induction with fentanyl versus dexmedetomidine and their effects on postoperative pain, post-anesthesia care unit (PACU) length of stay, and opioid consumption in children undergoing tonsillectomy. Methods: We retrospectively reviewed medical records of pediatric patients aged 3-16 years, who underwent tonsillectomy at King Abdullah Specialized Children's Hospital between January 2024 and December 2024. Patients were grouped by intraoperative induction regimen: fentanyl or dexmedetomidine. Outcomes included PACU pain scores, postoperative opioid use, PACU stay, adverse events, and hospital stay. Shapiro-Wilk was used to test normality; Mann-Whitney U was used when comparing continuous variables, and chi-square/Fisher was used when comparing categorical variables. Controlled logistic and linear regressions were used to adjust for the age, weight, and duration of a surgery. The analyses were conducted using Python 3.10. Results: = 0.002). Adverse event rates were lower in the adjusted analysis (OR: 0.11; 95% CI: 0.014-0.926). Hospital stay was comparable. Conclusion: Dexmedetomidine induction provides comparable analgesia to fentanyl while reducing adverse events, although it is associated with longer PACU stay. It may represent a safe opioid-sparing option in pediatric tonsillectomy, particularly in high-risk children.