NM-332
Implementation of a standardized analgesia protocol for idiopathic scoliosis surgery
Ye J, Whitaker S
Indiana University - Riley Children's Hospital, Indianapolis, IN, USA
Introduction: A multimodal analgesia protocol was implemented at Riley Children's Hospital for adolescents undergoing idiopathic scoliosis repair. Outcome measures were collected and compared to past surgical patients to see if there are any significant improvements.
Methods: A total of 25 patients were treated on the new multimodal analgesic protocol. Data were collected on these patients including time to hospital discharge, postoperative opioid usage, pain scores, and any complications. Additional data on 25 patients who had undergone the procedure prior to the implementation of the protocol were collected and compared. All patients were operated on by the same surgeon, and they all had idiopathic scoliosis. All the pre- and post- operative medication orders were entered by the anesthesia pain service for the patients on the protocol.
Results: The patients on the multimodal analgesia protocol had earlier discharge from hospital (POD2 vs POD3), lower pain scores on post operative day 0-2, with the most significant difference noted on POD1. Overall opioid usage was reduced for PCA, but not for oral analgesics. The only notable side effect was urinary retention, which occurred in 3/25 patients on the protocol, and was treated with Nubain and/or discharge with indwelling catheter.
Discussion: Spinal fusion for idiopathic scoliosis is a fairly common surgical procedure in pediatric hospitals. However, there is a high level of variance in postoperative pain management strategies among individual hospitals. Pain control methods have included intrathecal opioids, epidural infusion, implanted surgical incision catheters, and multimodal analgesic regimen. Our experience, combined with some of the recent published data from other institutions, seem to suggest that a multimodal analgesic regimen improves outcomes. Given the success of the implementation of ERAS protocol for colorectal surgery, perhaps we can apply a similar strategy to scoliosis surgery.
Conclusion: Standardized multimodal analgesia protocol helps to improve postoperative pain control and facilitate early discharge.
References:
Ljunggvist O. Scott M, Fearon KC. Enhanced Recovery After Surgery: A Review. JAMA Surg. 2017 Mar 1; 152(3): 292-298
Kim E, Lee B, Cucchiaro G. Perioperative Surgical Home: Evaluation of a New Protocol Focused on a Multidisciplinary Approach to Manage Children Undergoing Posterior Spinal Fusion Operation. Anesth Analg 2017 Sep; 125(3): 812-819
Gornitzky AL, Flynn JM, Muhly WT, Sankar WN. A Rapid Recovery Pathway for Adolescent Idiopathic Scoliosis That Improves Pain Control and Reduces Time to Inpatient Recovery After Posterior Spinal Fusion. Spine Deform. 2016 Jul; 4 (4): 288-295
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