A Retrospective Study on Perioperative IV Fluid Restriction After a Disaster-Induced Fluid Shortage: Postoperative Pain and Complication Outcomes in Pediatric Adenotonsillectomies

Intravenous fluids are integral to pediatric perioperative care, yet optimal fluid volumes during adenotonsillectomy remain debated. In 2024, Hurricane Helene disrupted IV fluid supply chains, necessitating an involuntary shift to restrictive intraoperative fluid administration. This event created an opportunity to evaluate whether reduced intraoperative fluids affected postoperative pain or complication rates in pediatric adenotonsillectomies. We conducted a retrospective cohort study of children under 12 years who underwent adenotonsillectomy between 1 October 2024, and 31 January 2025. Patients were stratified into a restrictive fluid group (<10 mL/kg) and a non-restrictive group (≥10 mL/kg). Collected data included demographics, intraoperative fluid volumes, postoperative FLACC pain scores, and documented complications. Pain scores were compared using Mann–Whitney U tests, due to non-normal data distribution with descriptive analysis. A total of 133 patients were included (63 restrictive, 70 non-restrictive). Mean postoperative FLACC scores were similar between groups (4.53 ± 2.62 vs. 4.57 ± 3.44; p = 0.50), with comparable operative times. Complications occurred in both groups without a consistent association with fluid strategy. These findings suggest that intraoperative fluid restriction below 10 mL/kg does not significantly affect postoperative pain or overall complication rates in pediatric adenotonsillectomy. Short-term fluid restriction may be safe in resource-limited settings, though prospective studies are warranted.