Effects of Opioid-Reduced Anesthesia During Scoliosis Surgery in Children: A Prospective Observational Study

Abstract

Aims: Opioid-reduced anesthesia (ORA) was suggested to decrease morphine consumption after adolescent idiopathic scoliosis (AIS) surgery and incidence of chronic pain. Materials & methods: A prospective analysis using the ORA in AIS surgery was performed. Two cohorts were compared: a control group (opioid-based anesthesia) and the ORA group. The main outcome was morphine consumption at day 1. Results: 33 patients operated for AIS using ORA were compared with 36 with opioid-based anesthesia. Morphine consumption was decreased in the ORA group (1.1 mg.kg-1 [0.2–2] vs 0.8 mg.kg-1 [0.3–2]; p = 0.02) at day 1. Persistent neuropathic pain at 1 year was decreased in the ORA group (p = 0.02). Conclusion: The ORA protocol is efficient to reduce postoperative morphine consumption in AIS surgery and preventing neuropathic pain.

The association between intraoperative fluid management and perioperative allogenic blood transfusion during adolescent idiopathic scoliosis surgery

“…Maintenance of anesthesia was performed using sevoflurane in a 50% mixture of O 2 /Air, and adjusted to maintain bispectral index (used in all patients) values between 40 and 60. Dexmedetomidine was then administered as an initial bolus of 0.4 mg.kg −1 over 10 min followed by an infusion of 0.04 μg.kg −1 .h −1 14–16 . In the event of bradycardia below 50 bpm, hypotension, or unusual bleeding, dexmedetomidine was discontinued, according to the judgment of the anesthesiologist responsible for the case, and sevoflurane was used as the sole hypnotic agent.…”

“…Dexmedetomidine was then administered as an initial bolus of 0.4 mg.kg −1 over 10 min followed by an infusion of 0.04 μg.kg −1 .h −1 . [14][15][16] In the event of bradycardia below 50 bpm, hypotension, or unusual bleeding, dexmedetomidine was discontinued, according to the judgment of the anesthesiologist responsible for the case, and sevoflurane was used as the sole hypnotic agent. Intraoperative sufentanil boluses (0.2 μg.kg −1 ) were administered to maintain mean arterial pressure and heart rate within 20% of the preoperative values.…”

Anesthesia and epidural analgesia for “heroic” cancer surgery

“…There are many advantages to be considered when designing a volatile agent‐free, opioid‐reduced anesthetic plan, and the components of the TIVA protocol, especially in patients with cancer. The opioid‐reduced anesthetic concept has been demonstrated to provide improvements in the quality of immediate postoperative pain management in a small sample of patients, as well as the long‐term consequences of development of chronic postsurgical pain 4 . Dexmedetomidine, via the alpha 2 receptor agonism, and ketamine, via the N‐methyl‐D‐aspartate (NMDA) receptor antagonism, provide nonopioid mechanisms to support analgesia, not only through their intrinsic effects, but also through the reduction of the development of acute opioid tolerance.…”

Pain Medication Use Two Years After Adolescent Idiopathic Scoliosis Fusion Surgery

“…18 Furthermore, the relationship between pain experience and mental health as measured by the Scoliosis Research Society (SRS)-22 questionnaire has been established in AIS patients. [25][26][27][28] Significant efforts have been focused on employing perioperative methods to reduce opioid consumption in the early postoperative period; [29][30][31][32][33][34] however, little is known about the prevalence of opioid use at later follow-up time points. Thus, the purpose of this study was to identify the prevalence of adolescents utilizing opioids for back pain two years after surgical correction of AIS and to evaluate whether a relationship exists between Mental Health, Pain, and Function domain scores from the Scoliosis Research Society (SRS) questionnaire and opioid usage.…”