Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction

Anderson, Devon E.; Duletzke, Nicholas T.; Pedigo, Elizabeth; Halsey, Matthew F.

doi:10.1007/s43390-020-00038-z

Cited by 39 publications

(42 citation statements)

References 23 publications

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“…Both the present trial and previous trials [ 19 , 21 ] found that a multiple-dose regimen of gabapentin may decrease both pain intensity and demand for opioids. This trial showed that administering gabapentin 15 mg/kg before surgery and 7.5 mg/kg every 12 h for 3 days after surgery resulted in a reduction in pain scores at rest (on the day of surgery and on the second postoperative day) and the need for morphine on the first postoperative day.…”

Section: Discussionsupporting

confidence: 67%

“…It is worth noting that these patients received the same daily dose of gabapentin both pre- and postoperatively as in our trial, but in the 5-day postoperative period, the total daily dose was divided into three single doses. The recent randomised, double-blind study conducted by Anderson et al [ 21 ] also confirmed the beneficial effects of gabapentin only through the first 48 h after surgery, despite administering a higher maintenance dose of this medication to patients (10 mg/kg every 8 h for 5 days).…”

Section: Discussionmentioning

confidence: 88%

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The Effects of Gabapentin on Post-Operative Pain and Anxiety, Morphine Consumption and Patient Satisfaction in Paediatric Patients Following the Ravitch Procedure—A Randomised, Double-Blind, Placebo-Controlled, Phase 4 Trial

Fenikowski

Tomaszek

Mazurek

et al. 2022

JCM

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The aim of the study was to investigate whether the use of pre- and postoperative gabapentin can decrease postoperative pain, morphine consumption, anxiety and side effects, as well as improve patient satisfaction. A total of 56 patients, 9–17 years of age, undergoing a modified Ravitch procedure, were randomised (allocation ratio 1:1) to receive multiple perioperative doses of gabapentin (preoperatively 15 mg/kg, postoperatively 7.5 mg/kg, two times per day for three days) or a placebo. All the patients received intravenous infusion of morphine, paracetamol and non-steroidal anti-inflammatory drugs. Metamizole was given as a “rescue drug”. The observation period included the day of surgery and three postoperative days. The primary outcomes were postoperative pain intensity (at rest, during deep breathing and coughing). Additional outcomes included the consumption of morphine, the total number of doses of metamizole, anxiety, postoperative side effects and patient satisfaction. Median average and maximal pain scores (on the day of surgery and on the second postoperative day) were significantly lower only in the gabapentin group at rest (p < 0.05). Compared to the placebo group, gabapentin treatment reduced the demand for morphine on the first postoperative day (median 0.016 vs. 0.019 mg/kg/h; p = 0.03) and the total number of metamizole doses (median 1 vs. 2 p = 0.04). Patient satisfaction was significantly greater in the gabapentin group (median 10 vs. 9; p = 0.018). Anxiety and postoperative side effects were similar in both groups (p > 0.05). Pre- and postoperative gabapentin administration as part of a multimodal analgesic regimen may decrease postoperative pain, opioid consumption and demand for a “rescue drug”, as well as improve patient satisfaction.

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Section: Discussionsupporting

confidence: 67%

Section: Discussionmentioning

confidence: 88%

The Effects of Gabapentin on Post-Operative Pain and Anxiety, Morphine Consumption and Patient Satisfaction in Paediatric Patients Following the Ravitch Procedure—A Randomised, Double-Blind, Placebo-Controlled, Phase 4 Trial

Fenikowski

Tomaszek

Mazurek

et al. 2022

JCM

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“…Major advances have been made in addressing these complications: sophisticated preoperative pain management, the treatment of anxiety and depression where present, postoperative pain prevention using perioperative gabapentin 2,6,13,14 or intraoperative dexmedetomidine, 15 the use of balanced analgesia combining nonopioid analgesics (especially nonsteroidal anti‐inflammatory drugs), 16,17 the use of single or double epidural analgesia, 18 and the prevention of nausea, vomiting, and constipation 19 . However, taken in isolation these measures remain insufficient 20 and multiple target enhancement such that performed during ERAS might potentially represent a very pertinent intervention in scoliosis surgery patients.…”

Section: Introductionmentioning

confidence: 99%

Enhanced recovery after surgical correction of adolescent idiopathic scoliosis

Julien-Marsollier

Michelet

Assaker

et al. 2020

Pediatric Anesthesia

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Recent evidence suggests that ERAS might also be suited to pediatric surgery 1,2 and might, as previously demonstrated in adults, have beneficial effects in terms of recovery, hospital length of stay (HLOS), and overall quality of care. 3,4 Scoliosis surgery is a major surgical procedure in pediatrics, 5,6 and the postoperative period is often very challenging. Intense postoperative pain and high postoperative opioid consumption 5,6 result in high incidences of nausea, vomiting, constipation, and urinary retention. Early efficacious physiotherapy is frequently hindered by pain and analgesic side effects. In addition, cognitive impairment,

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“… 1 2 3 4 This has been particularly true for children undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) where multimodal pain management strategies have been incorporated with early mobilization and have resulted in significant decreases in opioid medication and hospital LOS without differences in postdischarge complications. 5 6 7 8 9 10 11 12 13 …”

mentioning

confidence: 99%

“…[1][2][3][4] This has been particularly true for children undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) where multimodal pain management strategies have been incorporated with early mobilization and have resulted in significant decreases in opioid medication and hospital LOS without differences in postdischarge complications. [5][6][7][8][9][10][11][12][13] There has been a significant increase in publications for ERAS application in patients with AIS since the initial report in 2014. 4 The healthcare utilization and economic benefits of ERAS protocols suggest the potential for a significant societal effect [5][6][7][8]14,15 ; however, no study to date has investigated the nationwide effect of ERAS pathway utilization on the US healthcare system.…”

mentioning

confidence: 99%

Continued Increase in Cost of Care Despite Decrease in Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Shaw¹,

Ange²,

Varghese³

et al. 2022

JAAOS Glob Res Rev

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Introduction:Previous studies have demonstrated decreased hospital length of stay (LOS) for children undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).Methods:Hospitalization event data from the Kids Inpatient Database were queried for all PSF events for AIS performed in 2009, 2012, and 2016 using diagnosis and surgical codes. Data were subdivided into two groups: pre–enhanced recovery after surgery (ERAS) (2009 and 2012) and post-ERAS (2016). The primary outcome variables were LOS and total treatment charge (adjusted for 2020 inflation). Univariate and multivariate analysis were performed to identify differences in outcome variables.Results:A total of 12,010 unique hospitalization events were identified, 74% female, mean 14.3 years. There was a decrease in LOS (pre-ERAS: 5.4 ± 4.0 versus 4.3 ± 3.2 days, P < 0.0001) with an increase in adjusted total treatment charge (pre-ERAS $193,544.4 ± $108,116.1 versus $200,469.1 ± $110,112.6; P = 0.0013). Pre-ERAS, male sex, smaller hospital, and non-Medicaid insurance were predictive of longer LOS, whereas pre-ERAS, older age, non-White race, male sex, hospital outside the Northeast, and non-Medicaid insurance were predictive of higher treatment costs.Discussion:There continues to be a significant decrease in LOS for PSF hospitalization events for AIS; however, total treatment charges continue to rise. Future research should investigate potential factors influencing total treatment charges after PSF for AIS.

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Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction

Cited by 39 publications

References 23 publications

The Effects of Gabapentin on Post-Operative Pain and Anxiety, Morphine Consumption and Patient Satisfaction in Paediatric Patients Following the Ravitch Procedure—A Randomised, Double-Blind, Placebo-Controlled, Phase 4 Trial

The Effects of Gabapentin on Post-Operative Pain and Anxiety, Morphine Consumption and Patient Satisfaction in Paediatric Patients Following the Ravitch Procedure—A Randomised, Double-Blind, Placebo-Controlled, Phase 4 Trial

Enhanced recovery after surgical correction of adolescent idiopathic scoliosis

Continued Increase in Cost of Care Despite Decrease in Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

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