Risk Factors for Prolonged Postoperative Opioid Use After Spinal Fusion for Adolescent Idiopathic Scoliosis

Abstract Purpose: To investigate Hidden blood loss (HBL) and its potential risk factors in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgery and elucidate the influence of HBL on postoperative blood transfusion. Methods: We retrospectively studied 765 patients undergoing posterior spine fusion for adolescent idiopathic scoliosis from January 2014 to December 2018. The patient’s demographics, blood loss related parameters, operation and blood loss information were extracted. The association between patient’s characteristics and HBL was analyzed by Pearson or Spearman correlation analysis. Multivariate linear regression analysis was used to determine independent risk factors associated with HBL. Binary logistic regression analysis was used to analyze the influence of HBL on postoperative blood transfusion.Results: A total of 765 patients including 128 males and 637 females (age range 10-18 years) were included in this study. The mean amount of HBL was 693.5±473.4 ml, accounting for 53.9% of the total blood loss. In multivariate linear regression analysis, we found that preoperative Hct (p=0.003) and allogeneic blood transfusion (p<0.0001) were independent risk factors for HBL, while tranexamic acid (p=0.003) was negatively related to HBL. Binary logistic regression analysis showed that HBL > 850 ml ( P < 0.001, OR: 8.845, 95%CI: 5.806-13.290) was the independent risk factor for postoperative blood transfusion.Conclusion: a large amount of HBL was incurred in adolescent idiopathic scoliosis patients undergoing posterior spinal fusion surgeries. Allogeneic blood transfusion and preoperative Hct were independent risk factors for HBL, while tranexamic acid was negatively related to HBL. HBL and its influential factors should be taken into account when considering the perioperative transfusion management. These patients with HBL greater than 850 ml should be paid more attention in case of postoperative anemia.Level of evidence: Level III

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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

Journal of Orthopaedic Surgery and Research ◽

10.1186/s13018-021-02525-z ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Ying Li ◽

Jennylee Swallow ◽

Christopher Robbins ◽

Michelle S. Caird ◽

Aleda Leis ◽

...

Keyword(s):

Physical Therapy ◽

Postoperative Pain ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Intrathecal Morphine ◽

Posterior Spinal Fusion ◽

Trial Registration ◽

Opioid Use ◽

Pain Scores

Abstract 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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Risk Factors for the Development of Delayed Infections Following Posterior Spinal Fusion and Instrumentation in Adolescent Idiopathic Scoliosis Patients

Spine ◽

10.1097/brs.0b013e31814b1c0b ◽

2007 ◽

Vol 32 (20) ◽

pp. 2272-2277 ◽

Cited By ~ 96

Author(s):

Christine Ho ◽

Daniel J. Sucato ◽

B Stephens Richards

Keyword(s):

Risk Factors ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Posterior Spinal Fusion

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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

10.21203/rs.3.rs-455163/v1 ◽

2021 ◽

Author(s):

Ying Li ◽

Jennylee Swallow ◽

Christopoher Robbins ◽

Michelle S. Caird ◽

Aleda Leis ◽

...

Keyword(s):

Physical Therapy ◽

Postoperative Pain ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Intrathecal Morphine ◽

Posterior Spinal Fusion ◽

Trial Registration ◽

Opioid Use ◽

Pain Scores

Abstract 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 morphinealone 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 not applicable.

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