Perioperative Pain Management in Pediatric Spine Surgery

Sheffer, Benjamin W.; Kelly, Derek M.; Rhodes, Leslie N.; Sawyer, Jeffrey R.

doi:10.1016/j.ocl.2017.06.004

Cited by 23 publications

(15 citation statements)

References 25 publications

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“…2 In particular, pediatric patients undergoing spine surgery are likely to experience postsurgical pain, which may in turn affect exposure to opioids, length of stay (LOS) in the hospital, and medical costs. 3,4 Despite the associated opioid-related adverse events (ORAEs), opioids are commonly prescribed for pain management following pediatric surgery. [5][6][7][8][9] Prescription of opioids can be associated with misuse and development of persistent opioid use, particularly in adolescents, and ORAEs that may lead to substantial health-care resource utilization.…”

Section: Introductionmentioning

confidence: 99%

Clinical and Economic Outcomes Associated With Use of Liposomal Bupivacaine Versus Standard of Care for Management of Postsurgical Pain in Pediatric Patients Undergoing Spine Surgery

Ballock

Seif

Goodwin

et al. 2021

JHEOR

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Background: Approximately 60% of hospitalized children undergoing surgery experience at least 1 day of moderate-to-severe pain after surgery. Pain following spine surgery may affect opioid exposure, length of stay (LOS), and costs in hospitalized pediatric patients. This is a retrospective cohort analysis of pediatric patients undergoing inpatient primary spine surgery. Objectives: To examine the association of opioid-related and economic outcomes with postsurgical liposomal bupivacaine (LB) or non-LB analgesia in pediatric patients who received spine surgery. Methods: Premier Healthcare Database records (January 2015–September 2019) for patients aged 1–17 years undergoing inpatient primary spine surgery were retrospectively analyzed. Outcomes included in-hospital postsurgical opioid consumption (morphine milligram equivalents [MMEs]), opioid-related adverse events (ORAEs), LOS (days), and total hospital costs. A generalized linear model adjusting for baseline characteristics was used. Results: Among 10 189 pediatric patients, the LB cohort (n=373) consumed significantly fewer postsurgical opioids than the non-LB cohort (n=9816; adjusted MME ratio, 0.53 [95% confidence interval (CI), 0.45–0.61]; P<0.0001). LOS was significantly shorter in the LB versus non-LB cohort (adjusted rate ratio, 0.86 [95% CI, 0.80–0.94]; P=0.0003). Hospital costs were significantly lower in the LB versus non-LB cohort overall (adjusted rate ratio, 0.92 [95% CI, 0.86–0.99]; P=0.0227) mostly because of decreased LOS and central supply costs. ORAEs were not significantly different between groups (adjusted rate ratio, 0.84 [95% CI, 0.65–1.08]; P=0.1791). Discussion: LB analgesia was associated with shorter LOS and lower hospital costs compared with non-LB analgesia in pediatric patients undergoing spine surgery. The LB cohort had lower adjusted room and board and central supply costs than the non-LB cohort. These data suggest that treatment with LB might reduce hospital LOS and subsequently health-care costs, and additional cost savings outside the hospital room may factor into overall health-care cost savings. LB may reduce pain and the need for supplemental postsurgical opioids, thus reducing pain and opioid-associated expenses while improving patient satisfaction with postsurgical care. Conclusions: Pediatric patients undergoing spine surgery who received LB had significantly reduced in-hospital postsurgical opioid consumption, LOS, and hospital costs compared with those who did not.

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Section: Introductionmentioning

confidence: 99%

Clinical and Economic Outcomes Associated With Use of Liposomal Bupivacaine Versus Standard of Care for Management of Postsurgical Pain in Pediatric Patients Undergoing Spine Surgery

Ballock

Seif

Goodwin

et al. 2021

JHEOR

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“…[1][2][3]21,32,33,37,[43][44][45] Dentro del otro grupo de fármacos habitualmente utilizados en los esquemas para el manejo del dolor perioperatorio, están los AINE, hay que tener en cuenta su gastrotoxicidad, hepatotoxicidad, neurotoxicidad, cardiotoxicidad, anafilaxia e inhibición de la agregación plaquetaria, entre otros efectos. [1][2][3][4][5][6][7][8][9][10][11][12][16][17][18][19][22][23][24][32][33][34][35][36][37][38]40 La prevención y el manejo multimodal efectivo del dolor agudo mejorarían los resultados clínicos y la calidad de vida del paciente y su familia, evitarían complicaciones y disminuirían los costos familiares y del sistema de salud. [1][2][3][4][5][6][7][8][9][10]…”

Section: Discussionunclassified

Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría

Piantoni

Tello

Remondino

et al. 2022

Rev. Asoc. Arg. Ort. y Traumatol

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Introducción: La cirugía de columna es uno de los procedimientos con mayor morbimortalidad dentro de la población pediátrica; el manejo farmacológico del dolor en dicha población aún no se encuentra estandarizado. La analgesia multimodal trata de responder a esta problemática. Objetivo: Sobre la base de una revisión sistemática de la bibliografía, desarrollar un detallado protocolomultimodal farmacológico para el manejo del dolor pre- y posoperatorio intra/extrahospitalario para la cirugía de columna en niños. Materiales y Métodos: Se realizó una revisión sistemática de textos completos en inglés o español en PubMed, Embase, Cochrane Library y LILACS Database publicados entre 2000 y 2021; se aplicó el diagrama de flujo PRISMA. Resultados: De 756 artículos preseleccionados, 38 fueron incluidos en la evaluación final. Dada la dificultad bioética de desarrollar trabajos en formato de ensayos clínicos con fármacos y combinaciones de ellos en la población pediátrica, desarrollamos un protocolo detallado de manejo del dolor pre- y posoperatorio por vía intravenosa/oral, intra- y extrahospitalario, para aplicar en niños sometidos a cirugía de columna. Conclusión: Logramos desarrollar un detallado protocolo multimodal farmacológico para el perioperatorio intra- y extrahospitalario de cirugía de columna en niños, sencillo y reproducible, tendiente a acelerar la recuperación funcional del paciente y disminuir los costos socioeconómicos globales.Nivel de Evidencia: II

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“…Providing adequate postoperative analgesia and preventing back muscle spasms after posterior spinal fusion for adolescent idiopathic scoliosis (AIS) remains a challenge. 1 With patient assent and parental written consent, we report our experience of a patient with AIS who had excellent post-spinal fusion pain control and absence of back spasms with the use of surgically placed bilateral erector spinae plane catheters (SP-EC).…”

Section: To the Editormentioning

confidence: 99%

Moving toward patients being pain- and spasm-free after pediatric scoliosis surgery by using bilateral surgically-placed erector spinae plane catheters

Tsui

Esfahanian

Lin

et al. 2019

Can J Anesth/J Can Anesth

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Perioperative Pain Management in Pediatric Spine Surgery

Cited by 23 publications

References 25 publications

Clinical and Economic Outcomes Associated With Use of Liposomal Bupivacaine Versus Standard of Care for Management of Postsurgical Pain in Pediatric Patients Undergoing Spine Surgery

Clinical and Economic Outcomes Associated With Use of Liposomal Bupivacaine Versus Standard of Care for Management of Postsurgical Pain in Pediatric Patients Undergoing Spine Surgery

Protocolo multimodal farmacológico perioperatorio para la cirugía de columna en pediatría

Moving toward patients being pain- and spasm-free after pediatric scoliosis surgery by using bilateral surgically-placed erector spinae plane catheters

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