The Association Between Adjuvant Pain Medication Use and Outcomes Following Pediatric Spinal Fusion

Rosenberg, Rebecca E.; Trzcinski, Stacey; Cohen, Mindy; Erickson, Mark; Errico, Thomas J.; McLeod, Louise

doi:10.1097/brs.0000000000001892

Cited by 23 publications

(16 citation statements)

References 24 publications

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“…The combined use of acetaminophen/NSAIDs for opioid-based postoperative analgesia is widely applied after orthopaedic surgery including spinal fusion. There have been some reports investigating the effect of acetaminophen/NSAIDs on postoperative analgesia, focusing on spinal fusion surgery for scoliosis [ 12 – 14 ]. They showed that acetaminophen/NSAIDs reduced postsurgical pain.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of surgeon-directed postoperative local injection with an analgesic mixture in posterior fusion surgery for adolescent idiopathic scoliosis

Makino

Seki

Kamei

et al. 2022

BMC Musculoskelet Disord

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Background Severe postsurgical pain in posterior spinal fusion is common. Multimodality analgesia, including opioid-based patient-controlled analgesia (PCA), is commonly used, but opioid-related adverse events such as nausea and vomiting are sometimes a problem. We used a ropivacaine-epinephrine-dexamethasone mixture given as one-time local bilateral submyofascial injections at the operated levels added to conventional multimodality analgesia including PCA for postoperative pain control in one group of patients to confirm whether administration of this mixture reduced postoperative pain and opioid use status post posterior spinal fusion. Methods We retrospectively reviewed 67 consecutive patients who had undergone posterior fusion surgery for adolescent idiopathic scoliosis (AIS), 35 of whom were treated with conventional analgesia that consisted mainly of PCA (control group) and 32 of whom were treated with one-time submyofascial injections of a ropivacaine-epinephrine-dexamethasone mixture (submyofascial injection group) added to conventional multimodality analgesia. We compared postsurgical pain levels and the amount of opioid use over the first 48 h after surgery, as well as physical activity levels and adverse events 2 weeks after surgery. Results Postsurgical pain quantified by a numeric rating scale (1–10) in the submyofascial injection group was significantly lower than that in the control group. The amount of fentanyl use was significantly less in the submyofascial injection group at 24 h, 48 h, and all subsequent periods after surgery. In addition, Walking Recovery Time (WRT) defined as the number of days until the first event of ambulation was significantly less in the submyofascial injection group (3.3 d vs 4.1 d, P = 0.0007)). Laxative use was significantly less in the submyofascial injection group (0.3 times vs 1.3 times, P = 0.02). Conclusions One-time submyofascial injections at the operated levels with a ropivacaine-epinephrine-dexamethasone mixture after spinal fusion surgery reduced pain, opioid consumption, and opioid-related adverse events. This technique can contribute significantly to postoperative analgesia.

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Section: Discussionmentioning

confidence: 99%

Efficacy of surgeon-directed postoperative local injection with an analgesic mixture in posterior fusion surgery for adolescent idiopathic scoliosis

Makino

Seki

Kamei

et al. 2022

BMC Musculoskelet Disord

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“…33 A 2017 database study using ICD9 codes for scoliosis and PSF procedure involving 7349 subjects at 38 children's hospitals found that gabapentinoid use was significantly associated with decreased odds of prolonged IV opioid use (OR 0.63, 95% CI 0.53-0.75) and called for further trials. 34 A recent randomized controlled trial involving 50 patients aged 10-19 found that pre and postoperative administration of gabapentin as an adjuvant to multimodal narcotic and NSAID analgesia significantly decreased both opioid use and visual analog pain scales in the first two postoperative days and suggested that gabapentin be considered as a standard medication for perioperative pain control in this population. 35 Another randomized study found decreased initial pain scores but no change in opioid related side effects with adjuvant gabapentin use.…”

Section: Gabapentin/pregabalinmentioning

confidence: 99%

“…43 A chart review of 7349 patient records from 38 children's hospitals found that postoperative ketorolac use was associated with decreased likelihood of prolonged IV opioid exposure. 34 A prospective, randomized, double-blinded, placebo-controlled trial with 36 adolescents assessing analgesic effects of low-dose ketorolac in conjunction with PCA found that compared to PCA alone, the ketorolac group had significantly lower pain scores on POD 1 and 2 and tolerated activity better on POD 1 with no differences in incidence of pruritus, nausea, vomiting, or constipation and no difference in incidence of curve progression, hardware failure, or back pain in the 2 years following spinal fusion. 44…”

Section: Nsaids or Acetaminophen As Adjuvantsmentioning

confidence: 99%

Postoperative Analgesia After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Shah¹,

Pey²,

Bowen³

et al. 2021

Journal of the Pediatric Orthopaedic Society of North America

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PSF for AIS are young women who are particularly susceptible to pain. 1 Current postoperative pain management strategies are diverse and multimodal, with variation in analgesic efficacy as well as adverse events. The purpose of this current concept review is to synthesize all available data from randomized and observational studies to provide a comprehensive overview of the use and key advantages of different analgesic treatment modalities after posterior spinal fusion in patients with adolescent idiopathic scoliosis.

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“…Multimodal pain management has been found to improve the quality of analgesia and reduce medication-related side effects after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) [ 1 – 7 ]. Prior studies have shown that perioperative gabapentin, an effective drug for neuropathic pain, combined with intravenous patient-controlled analgesia (PCA) reduces initial postoperative pain scores, postoperative opioid use, and time to completing physical therapy goals compared to PCA alone after PSF for AIS [ 1 , 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis

et al. 2021

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Background Gabapentin and intravenous patient-controlled analgesia (PCA) can reduce postoperative pain scores, postoperative opioid use, and time to completing physical therapy compared to PCA alone after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Gabapentin combined with intrathecal morphine has not been studied. The primary purpose of this retrospective study was to evaluate whether perioperative gabapentin and intrathecal morphine provide more effective pain control than intrathecal morphine alone after PSF for AIS. Methods Patients aged 11 to 18 years who underwent PSF for AIS were identified. Patients who received intrathecal morphine only (ITM group) were matched by age and sex to patients who received intrathecal morphine and perioperative gabapentin (ITM+GABA group). The ITM+GABA group received gabapentin preoperatively and for up to 2 days postoperatively. Both groups received oxycodone and the same non-narcotic adjuvant medications. Results Our final study group consisted of 50 patients (25 ITM, 25 ITM+GABA). The ITM+GABA group had significantly lower mean total oxycodone consumption during the hospitalization (0.798 vs 1.036 mg/kg, P<0.015). While the ITM group had a lower mean pain score between midnight and 8 am on POD 1 (2.4 vs 3.7, P=0.026), pain scores were significantly more consistent throughout the postoperative period in ITM+GABA group. The ITM+GABA group experienced less nausea/vomiting (52% vs 84%, P=0.032) and pruritus (44% vs 72%, P=0.045). Time to physical therapy discharge and length of hospital stay were similar. Conclusion Addition of gabapentin resulted in reduced oral opioid consumption and more consistent postoperative pain scores after PSF for AIS. The patients who received intrathecal morphine and gabapentin also experienced a lower rate of nausea/vomiting and pruritus. Trial registration All data was collected retrospectively from chart review, with institutional IRB approval. Trial registration is not applicable.

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The Association Between Adjuvant Pain Medication Use and Outcomes Following Pediatric Spinal Fusion

Abstract: 3.

Cited by 23 publications

References 24 publications

Efficacy of surgeon-directed postoperative local injection with an analgesic mixture in posterior fusion surgery for adolescent idiopathic scoliosis

Efficacy of surgeon-directed postoperative local injection with an analgesic mixture in posterior fusion surgery for adolescent idiopathic scoliosis

Postoperative Analgesia After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Gabapentin and intrathecal morphine combination therapy results in decreased oral narcotic use and more consistent pain scores after posterior spinal fusion for adolescent idiopathic scoliosis

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