Comparing Analgesic Regimen Effectiveness and Safety for Surgery for Kids Trial

Inclusion Criteria:

• No significant analgesic medication use before surgery as defined in the protocol.For this study, we define significant analgesic medication use before surgery asprescriptions reported by the child or caregiver for 6 days or more of opioidmedications in the past 90 days (aligning with American Pediatric Guidelines thatwere published in September 2024 after the project was funded), excepting surgicalteam prescriptions within the week of surgery.

• Undergo one the following: tonsil removal (with or without adenoid removal),gallbladder removal (laparoscopic), and knee scope (arthroscopy).

Exclusion Criteria:

• Anticipated other surgery within 12 months

• Anticipated life expectancy of <12 months

• Those that have legal guardians (due to special permission to enroll in trials)

• Participants with complex chronic conditions per the Pediatric Medical ComplexityAlgorithm (e.g., trisomy 21)

• Patients with contraindications to non-steroidal anti-inflammatory drug (NSAID)drugs in the NSAID arm, opioid drugs in the opioid arm, or acetaminophen will beexcluded.

• Liver disease

• Acute psychiatric instability (defined as current uncontrolled severe depression,severe post-traumatic stress disorder (PTSD), or suicidal ideation), substance usedisorder not in remission or treatment, and history of diversion of controlledsubstances (opioids)