Postoperative pain relief using intermittent intrapleural analgesia following thoracoscopic anterior correction for progressive adolescent idiopathic scoliosis

Background: Buprenorphine is a semisynthetic derivative of thebaine which is 75–100 times more potent than morphine and causes less respiratory depression. Efficacy and safety of transdermal buprenorphine have been well established in chronic pain, but data regarding acute postoperative pain relief are still limited. Aim: In this study we compared the efficacy of transdermal buprenorphine patch with injectable tramadol for the relief of postoperative pain (POP) following abdominal hysterectomy for benign gynecological conditions. Settings and design: three-year prospective observational study. Methods and material: One hundred patients undergoing abdominal hysterectomy were allocated to one of two groups. Buprenorphine group: we applied 10 mcg/hr transdermal buprenorphine patch on the lateral upper arm after surgery. The onset of relief from a patch is 8 to 16 hours. So, all patients were given diclofenac suppository 100mg before induction of anesthesia as preemptive analgesic to reduce postoperative pain. Injectable tramadol group : received intramuscular tramadol injections 50mg every 8 hours in the postoperative period. Patients were followed for two days to look for postoperative pain relief and adverse effects. If patients showed a visual analog pain (VAS) score >3, intravenous paracetamol was administered as rescue analgesic. Results: POP was assessed at different time frames: 12, 24, 36 and 48 hours after hysterectomy. Mean pain score at rest, in buprenorphine group was significantly lower than that of the tramadol group. Patients experienced less pain on mobility in the buprenorphine group compared with the tramadol group, which was statistically significant. Conclusion: We concluded that transdermal buprenorphine is an effective and safe alternative to injectable tramadol for providing postoperative analgesia. It provides a higher degree of pain relief, faster postoperative mobilization, lower incidence of postoperative nausea and vomiting and higher satisfaction scores starting 12 hours after surgery. However, for the first 12 post-operative hours, there is need for additional analgesia.

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953 Role of Routine Preoperative Echocardiograms in Adolescent Idiopathic Scoliosis Patients undergoing Deformity Correction Surgery

British Journal of Surgery ◽

10.1093/bjs/znab134.339 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

A Hassan ◽

S Shah ◽

M Patel

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Clinical Assessment ◽

Clinical Symptoms ◽

Deformity Correction ◽

Cost Effective ◽

Cardiovascular Complications ◽

Anterior Correction ◽

Perioperative Complication ◽

Clinical Records

Abstract Introduction Patients with Adolescent Idiopathic Scoliosis (AIS) are often noted to have routine preoperative Echocardiograms (ECHO). The prevalence of ECHO abnormalities and their impact on perioperative outcome is not clear, especially balancing against its costs. The study aims at identifying the significance of routine preoperative ECHO for AIS patients. Methodology Clinical records of 295 adolescent AIS patients, >10years age (mean 15.64years), who underwent primary posterior corrective surgery in a tertiary spinal centre, between 2015-2020, were reviewed. Patients with revision surgery, anterior correction, syndromic/neuromuscular scoliosis and/or pre-existent known cardiac comorbidities were excluded. Results 139(47%) patients had preoperative ECHO. 21(15%) patients showed echocardiographic abnormalities (11 trivial valvular abnormalities, 5 mild root dilatation, 3 mild pericardial effusion and 2 septal defects). None of these patients showed any clinical symptoms/signs or required Cardiology assessment; and none had perioperative cardiovascular complications. Conversely, four(1.36%) patients demonstrated auscultatory murmurs on preoperative clinical assessment. None reported any perioperative complication. The average known cost of an echocardiogram was noted to be £363. Conclusions Routine preoperative Echocardiogram for all AIS patients is not recommended or deemed cost-effective. Positive clinical assessment finding could be used as a screening tool for performing ECHO in AIS patients.

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