Intraoperative Dexmedetomidine has no Effect on Postoperative Pain Scores for Posterior Spinal Fusion

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.

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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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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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A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis

Pediatric Anesthesia ◽

10.1111/pan.13037 ◽

2016 ◽

Vol 27 (1) ◽

pp. 91-97 ◽

Cited By ~ 14

Author(s):

Rebecca A. Hong ◽

Kathleen M. Gibbons ◽

G. Ying Li ◽

Ashlee Holman ◽

Terri Voepel-Lewis

Keyword(s):

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Intrathecal Morphine ◽

Posterior Spinal Fusion ◽

Retrospective Comparison

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Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

Scoliosis and Spinal Disorders ◽

10.1186/s13013-018-0165-z ◽

2018 ◽

Vol 13 (1) ◽

Cited By ~ 3

Author(s):

Hiroyuki Seki ◽

Satoshi Ideno ◽

Taiga Ishihara ◽

Kota Watanabe ◽

Morio Matsumoto ◽

...

Keyword(s):

Pain Management ◽

Postoperative Pain ◽

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Postoperative Pain Management ◽

Posterior Spinal Fusion ◽

Narrative Review

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Intrathecal Morphine for Postoperative Analgesia in Patients With Idiopathic Scoliosis Undergoing Posterior Spinal Fusion

Spine ◽

10.1097/brs.0b013e31817bd8be ◽

2008 ◽

Vol 33 (20) ◽

pp. 2248-2251 ◽

Cited By ~ 23

Author(s):

Paul A. Tripi ◽

Connie Poe-Kochert ◽

Jennifer Potzman ◽

Jochen P. Son-Hing ◽

George H. Thompson

Keyword(s):

Idiopathic Scoliosis ◽

Spinal Fusion ◽

Postoperative Analgesia ◽

Intrathecal Morphine ◽

Posterior Spinal Fusion

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A comparative study of coblation assissted adenotonsillectomy and cold dissection adenotonsillectomy in children

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20164814 ◽

2016 ◽

Vol 3 (1) ◽

pp. 122 ◽

Cited By ~ 1

Author(s):

Nithya V. ◽

Angshuman Dutta ◽

Sabarigirish K.

Keyword(s):

Postoperative Pain ◽

Blood Loss ◽

Postoperative Period ◽

P Value ◽

Intraoperative Blood Loss ◽

Pain Scores ◽

Significant Difference ◽

Duration Of Surgery ◽

The Mean ◽

Cold Dissection

Background: The aim of the present study was to compare intraoperative blood loss, operative duration and postoperative pain between coblation-assisted adenotonsillectomy and cold dissection adenotonsillectomy in children.Methods: A prospective, randomized, single-blind trial of pediatric patients aged 7 to 13 years undergoing adenotonsillectomy was conducted. Patients were randomized to undergo either cold dissection or coblation-assisted adenotonsillectomy. Measured intraoperative parameters included surgical duration and intraoperative blood loss. Measured postoperative parameters included a daily pain rating using the visual analog scale on the postoperative evening, postoperative day 1 and day 7. Intraoperative and postoperative measures were statistically compared between the two groups. Results: Sixty children were randomized and included in the study. 30 patients underwent cold dissection adenotonsillectomy and 30 coblation-assisted adenotonsillectomy. Mean age was 8.7 years in the coblation group and 9.1 years in the cold dissection group. Intraoperative blood loss was lower for the coblation assisted adenotonsillectomy group versus the cold dissection adenotonsillectomy group which was proved statistically (mean bleeding was 16.67 in coblation group and 58.67 in cold dissection group and p value <0.0001).There was statistically no significant difference in the mean pain scores in the 2 groups in the postoperative evening and on postoperative day 1. The mean pain scores on postoperative day 7 were found to be 3.4 in the coblation group and 2.47 in the cold dissection group with a significant p value of 0.0087. The average duration of surgery in the coblation group was 55.6 minutes as against 34.1 minutes in the cold dissection group. The p- value was found to be less than 0.0001 which makes the difference statistically significant. Conclusions: This study found that the intraoperative blood loss was significantly less in Coblation adenotonsillectomy than in cold dissection adenotonsillectomy. The duration of surgery in Coblation assisted adenotonsillectomy is significantly greater than the duration of surgery in cold dissectionadenotonsillectomy. While the postoperative pain scores are similar with coblation and cold dissection adenotonsillectomy in the early postoperative period, it is significantly more with coblation in the late postoperative period.

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