Pregabalin and Persistent Postoperative Pain Following Posterior Spinal Fusion in Children and Adolescents

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Linda Helenius ◽  
Tommi Yrjälä ◽  
Hanna Oksanen ◽  
Olli Pajulo ◽  
Eliisa Löyttyniemi ◽  
...  
2019 ◽  
Vol 32 (5) ◽  
pp. 210-214 ◽  
Author(s):  
Stacey Trzcinski ◽  
Rebecca E. Rosenberg ◽  
Dennis Vasquez Montes ◽  
Akhila Sure ◽  
Peter Zhou ◽  
...  

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Ying Li ◽  
Jennylee Swallow ◽  
Christopher Robbins ◽  
Michelle S. Caird ◽  
Aleda Leis ◽  
...  

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.


2021 ◽  
Vol 15 (1) ◽  
pp. 1-6
Author(s):  
Rebecca A. Hong ◽  
Aleda Leis ◽  
James Weinberg ◽  
G. Ying Li

Background: Posterior Spinal Fusion (PSF) for idiopathic scoliosis results in severe postoperative pain. At our institution, a protocol for postoperative analgesia is followed, but anesthetic maintenance is decided by the anesthesiologist. Previous studies have shown that postoperative use of dexmedetomidine may improve analgesia for these patients, but the effect of intraoperative dexmedetomidine on postoperative pain scores remains unknown. Purpose: We sought to retrospectively compare pain scores from the Postoperative Anesthesia Care Unit (PACU) and from PACU discharge until midnight between PSF patients who did and did not receive intraoperative dexmedetomidine. Methods: After obtaining IRB approval, we retrospectively identified 79 patients aged 10-17 years who had undergone PSF for idiopathic scoliosis from June 2015-August 2018 and who received intrathecal morphine. Patients were then divided into two groups based on whether or not they received intraoperative dexmedetomidine. A multivariable linear regression model was constructed with the dependent variable of highest PACU pain score and exposure of interest intraoperative dexmedetomidine use. Secondary analyses were conducted similarly within those who received dexmedetomidine to examine the effects of dose on PACU pain scores, using a p-value < 0.05. Results: After adjusting for age, weight, sex, levels fused, intrathecal morphine, diazepam, and ketamine doses, there was no statistically significant difference in average PACU pain scores between those who did and did not receive intraoperative dexmedetomidine (β = -0.85, 95% CI: -2.48, 0.68; p = 0.31). Conclusion: Intraoperative use of dexmedetomidine during posterior spinal fusion for adolescent idiopathic scoliosis appears to have no effect on postoperative pain scores.


2021 ◽  
Author(s):  
Ying Li ◽  
Jennylee Swallow ◽  
Christopoher Robbins ◽  
Michelle S. Caird ◽  
Aleda Leis ◽  
...  

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.


1989 ◽  
Vol &NA; (249) ◽  
pp. 223???226 ◽  
Author(s):  
L. AMARANATH ◽  
JACK T. ANDRISH ◽  
ALAN R. GURD ◽  
GARRON G. WEIKER ◽  
HELEN YOON

Author(s):  
Arati Patil ◽  
Sophie R. Pestieau

Scoliosis is defined as an abnormal curvature of the spine, which, if severe enough, can affect pulmonary or cardiac function and ultimately require surgical repair. There are 3 well-defined types of scoliosis: idiopathic, neuromuscular, and congenital scoliosis. Anesthetic management of children undergoing posterior spinal fusion can be challenging due to patient comorbidities, the need for neuromonitoring, the potential for significant blood loss, and various perioperative complications. In addition, postoperative pain after spinal fusion is known to be severe and often exceeds those reported in other major surgical procedures. To properly care for these patients, it is vital to be knowledgeable about the anesthetic and pain management considerations of patients undergoing posterior spinal fusion.


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