Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial

Mayell, Antonia; Srinivasan, Ilavajady; Campbell, Fiona; Peliowski, Arie

doi:10.1111/pan.12524

Cited by 86 publications

(48 citation statements)

References 24 publications

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“…One study reported improved early pain scores and reduced opioid consumption in the first 48 hours after surgery with preoperative and postoperative gabapentin administration, 7 whereas another study found no difference in pain scores after a single preoperative dose. 15 Intravenous acetaminophen has been proposed as a useful adjuvant in pain management after major orthopedic surgery 8 and, within pediatric PSF patients, intravenous acetaminophen has been shown to improve early pain scores but has no effect on opioid consumption. 16 Ketorolac has been shown to improve analgesia and reduce opioid consumption while reducing both opioid-related gastrointestinal side effects and LOS in general pediatric orthopedic populations 17,18 and pediatric spinal fusion populations.…”

Section: Discussionmentioning

confidence: 99%

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

et al. 2016

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BACKGROUND: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant pain and prolonged hospitalization. There is evidence that early mobilization and multimodal analgesia can accelerate functional recovery and reduced length of stay (LOS). Using these principles, we implemented a quality improvement initiative to enable earlier functional recovery in our AIS–PSF population. METHODS: We designed and implemented a standardized rapid recovery pathway (RRP) with evidence-based management recommendations for children aged 10 to 21 years undergoing PSF for AIS. Our primary outcome, functional recovery, was assessed using statistical process control charts for LOS and average daily pain scores. Our process measures were medication adherence and order set utilization. The balancing measure was 30-day readmission rate. RESULTS: We included 322 patients from January 1, 2011 to June 30, 2015 with 134 (42%) serving as historical controls, 104 (32%) representing our transition population, and 84 (26%) serving as our RRP population. Baseline average LOS was 5.7 days and decreased to 4 days after RRP implementation. Average daily pain scores remained stable with improvement on postoperative day 0 (3.8 vs 4.9 days) and 1 (3.8 vs 5 days) after RRP implementation. In the second quarter of 2015, gabapentin (91%) and ketorolac (95%) use became routine and order set utilization was 100%. Readmission rates did not increase as a result of this pathway. CONCLUSIONS: Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced LOS without an increase in reported pain scores or readmissions.

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Section: Discussionmentioning

confidence: 99%

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

et al. 2016

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“…Mayell et al 19 demonstrated that patients who received a single preoperative dose of gabapentin did not show significant improvement in opioid consumption or pain scores in this population. However, when preoperative gabapentin was used as part of a standardized RRP, including the use of intraoperative methadone and ketorolac, pain scores were improved 20…”

Section: Discussionmentioning

confidence: 89%

“…Preoperative gabapentin administration has been studied in a randomized controlled trial19 and as part of a rapid recovery pathway (RRP) for spinal fusion 20. Mayell et al 19 demonstrated that patients who received a single preoperative dose of gabapentin did not show significant improvement in opioid consumption or pain scores in this population.…”

Section: Discussionmentioning

confidence: 99%

Fentanyl versus remifentanil-based TIVA for pediatric scoliosis repair: does it matter?

Kars

Mori

Ahn

et al. 2019

Reg Anesth Pain Med

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IntroductionOpioid-induced hyperalgesia (OIH) and acute opioid tolerance have been demonstrated extensively in patients undergoing adolescent idiopathic scoliosis (AIS) repair. Remifentanil infusion has been strongly linked to both tolerance and OIH in these patients; however, the impact of using an intraoperative fentanyl infusion has not been well studied. This study aims to determine if patients undergoing operative management of AIS have decreased opioid consumption and pain scores when an intraoperative fentanyl infusion is used as compared with a remifentanil infusion.MethodsThis is a retrospective chart review of patients with AIS who underwent posterior spinal fusion. During the period January 2012–June 2013, patients received remifentanil infusion as part of total intravenous anesthesia. From July 2013 to June 2015, remifentanil was replaced by fentanyl as standard protocol. The remifentanil cohort included 37 patients and the fentanyl cohort included 25 patients. The primary outcome was the total opioid consumption (morphine equivalents) in the first 24 hours postsurgery. Secondary outcomes included mean postoperative pain score in the first 24 hours postsurgery, postoperative opioid consumption 24–48 hours after surgery, time to extubation, time to assisted ambulation, length of stay, and incidence of postoperative nausea and vomiting.ResultsCompared with the remifentanil group, the fentanyl group had significantly higher postoperative opioid usage during the first 48 hours and significantly higher postoperative mean pain score during the first 24 hours. There was no difference between the two groups in mean pain score for 24–48 hours, extubation time, time to assisted ambulation, length of stay, or postoperative nausea and vomiting.DiscussionDespite concerns for hyperalgesia and acute tolerance, remifentanil is widely used for intraoperative opioid infusions for surgical correction of AIS. This retrospective study examined a practice change from intraoperative remifentanil to intraoperative fentanyl as a potential approach to avoid OIH. Surprisingly, patients receiving fentanyl intraoperatively showed increased postoperative opioid use and pain scores in the first 24 hours postsurgery compared with the prior cohort receiving remifentanil. Substitution of fentanyl for remifentanil during surgical correction of AIS does not appear to solve the problem of OIH or acute tolerance. Prospective studies are needed to confirm this unexpected result.

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“…no hallaron relación entre determinadas variables (edad, sexo, índice de masa corporal, posición económica familiar, grado de deformidad y duración de la cirugía) y su concepción del dolor durante el posoperatorio, lo que ayudó a sostener que el dolor es una respuesta a múltiples factores que no tienen relación entre la gravedad de la deformidad y las variables demográficas. [40][41][42][43][44] Desde la perspectiva de nuestra heterogénea población, y al revaluarla en subgrupos, podemos coincidir con dicho argumento. En otro estudio, estos mismos autores hicieron referencia a que la concepción del dolor preoperatorio es un factor predictivo importante de la duración de la estancia hospitalaria después de la cirugía, por lo cual es preciso controlarlo farmacológica y no farmacológicamente antes del procedimiento quirúrgico.…”

Section: Discussionunclassified

Manejo del dolor posoperatorio por cirugía de columna en la población pediátrica. Resultados preliminares.[Pain mangement following spinal surgeries in pediatric patients. Preliminary results]

Piantoni

Tello

Wilson

et al. 2019

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: Aproximadamente el 80% de los pacientes pediátricos sometidos a cirugía de columna refiere dolor moderado o severo en el posoperatorio inmediato.Objetivos: Describir la presencia de dolor y su intensidad durante el posoperatorio de una cirugía de columna en pacientes pediátricos y evaluar la eficacia del tratamiento analgésico actual.Materiales y Métodos: Se evaluaron pacientes sometidos a cirugía de columna, de entre 10 y 18 años, con capacidad mental para entender el propósito del estudio. Se utilizó el esquema de medicación estándar actual posoperatorio del hospital. Se constataron la presencia del dolor, la hora de comienzo, la localización y la intensidad (escala de valoración numérica), entre otras variables.Resultados: Se evaluó a 84 pacientes pediátricos, con una edad promedio de 12 años y 9 meses, al momento de la cirugía. Las etiología fueron: idiopática (41 casos), neuropática (14 casos), sindrómica (10 casos), muscular (7 casos) y misceláneas (12 casos). El puntaje promedio en la escala de valoración numérica fue de 2,1 antes de la cirugía; de 7,3 el día 1 posoperatorio y de 3,3 el día 6 posoperatorio/alta. El tiempo promedio de internación fue de 6.3 días, el costo económico global de la internación fue de USD1090 por paciente.Conclusiones: Un importante porcentaje de pacientes pediátricos refiere dolor moderado o severo en el posoperatorio de una cirugía de columna, tan solo la mitad recibe un esquema de manejo de dolor estandarizado y adecuado. El objetivo ulterior de este estudio será protocolizar el manejo del dolor con un enfoque multimodal.AbstractIntroduction: Around 80% of pediatric patients who undergo spine surgery report moderate to severe pain in the immediate postoperative (POP) period, and only half of them are treated according to an adequate and standardized pain management scheme.Objectives: To describe the type and intensity of POP pain in children who underwent spinal surgery and evaluate the effectiveness of the current pain management protocol.Materials and Methods: We assessed children between 10 and 18 years of age who were able to understand the purpose of the study. We recorded presence of pain, time of POP pain onset, location, and referred intensity of the pain using a numeric rating scale (NRS), among other variables.Results: Overall, 84 pediatric patients were evaluated. Mean age at surgery: 12 years and 9 months. Etiology: idiopathic (41 patients), neuropathic (14 patients), syndromic (10 patients), muscular (7 patients), and miscellaneous (12 patients). Mean preoperative NRS was 2.1 and 7.3 on POP day 1, 6.6 on POP day 2, 6.2 on POP day 3, 5.1 on POP day 4, 3.7 on POP day 5, and 3.3 on POP day 6/at discharge. Mean hospital stay was6.3 days. The mean cost of hospital stay was USD 1090 per patient.Conclusions: A high percentage of pediatric patients who underwent spinal surgery reported moderate to severe pain in the POP period, and just half of them received a standardized pain management protocol. A pain management protocol with a multimodal focus should be considered in a near future.

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Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial

Cited by 86 publications

References 24 publications

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

Fentanyl versus remifentanil-based TIVA for pediatric scoliosis repair: does it matter?

Manejo del dolor posoperatorio por cirugía de columna en la población pediátrica. Resultados preliminares.[Pain mangement following spinal surgeries in pediatric patients. Preliminary results]

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