Postoperative pain management after spinal fusion surgery: an analysis of the efficacy of continuous infusion of local anesthetics
Richard A K Reynolds, Julie E Legakis, Jillian Tweedie, Youngkey Chung, Emily J Ren, Patricia A Bevier, Ronald L Thomas, Suresh T Thomas, Richard A K Reynolds, Julie E Legakis, Jillian Tweedie, Youngkey Chung, Emily J Ren, Patricia A Bevier, Ronald L Thomas, Suresh T Thomas
Abstract
Spinal fusion surgery is a major surgery that results in severe postoperative pain, therefore pain reduction is a primary concern. New strategies for pain management are currently under investigation and include multimodal treatment. A 3-year retrospective analysis of patients with idiopathic scoliosis undergoing spinal fusion surgery was performed at our hospital, assessing patient pain scores, opioid use, and recovery. We evaluated the effect of adding continuous infusion of local anesthetics (CILA) to a postoperative pain management protocol that includes intraoperative intrathecal morphine, as well as postoperative patient-controlled analgesia and oral opioid/acetaminophen combination. The study compared 25 patients treated according to the standard protocol, with 62 patients treated with CILA in addition to the pain management protocol. Patients in the CILA group used nearly 0.5 mg/kg less opioid analgesics during the first 24 hours after surgery.
Keywords: continuous infusion of local anesthetics; idiopathic scoliosis; post-operative pain management; spinal fusion.
Conflict of interest statement
Disclosures Richard A. K. Reynolds, None Julie E. Legakis, None Jillian Tweedie, None YoungKey Chung, None Emily J. Ren, None Patricia A. BeVier, None Ronald L. Thomas, None Suresh T. Thomas, None
Figures
References
- Weinstein S L, Dolan L A, Cheng J CY, Danielsson A, Morcuende J A. Adolescent idiopathic scoliosis. Lancet. 2008;371:1527–1537.
- Miller N H. Genetics of familial idiopathic scoliosis. Clin Orthop Relat Res. 2007;462:6–10.
- Raw D A, Beattie J K, Hunter J M. Anaesthesia for spinal surgery in adults. Br J Anaesth. 2003;91:886–904.
- Hawes M C, O'Brien J P. A century of spine surgery: what can patients expect? Disabil Rehabil. 2008;30:808–817.
- Weiss H-R. Adolescent idiopathic scoliosis (AIS)—an indication for surgery? A systematic review of the literature. Disabil Rehabil. 2008;30:799–807.
- Negrini S. Approach to scoliosis changed due to causes other than evidence: patients call for conservative (rehabilitation) experts to join in team orthopedic surgeons. Disabil Rehabil. 2008;30:731–741.
- Dolan L A Weinstein S L Surgical rates after observation and bracing for adolescent idiopathic scoliosis: an evidence-based review Spine 200732(19, Suppl):S91–S100.
- Tobias J D. A review of intrathecal and epidural analgesia after spinal surgery in children. Anesth Analg. 2004;98:956–965.
- Viscusi E R. Patient-controlled drug delivery for acute postoperative pain management: a review of current and emerging technologies. Reg Anesth Pain Med. 2008;33:146–158.
- Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol. 2008;21:313–316.
- Sucato D J, Duey-Holtz A, Elerson E, Safavi F. Postoperative analgesia following surgical correction for adolescent idiopathic scoliosis: a comparison of continuous epidural analgesia and patient-controlled analgesia. Spine. 2005;30:211–217.
- Cassady J F Jr, Lederhaas G, Cancel D D, Cummings R J, Loveless E A. A randomized comparison of the effects of continuous thoracic epidural analgesia and intravenous patient-controlled analgesia after posterior spinal fusion in adolescents. Reg Anesth Pain Med. 2000;25:246–253.
- Van Boerum D H, Smith J T, Curtin M J. A comparison of the effects of patient-controlled analgesia with intravenous opioids versus epidural analgesia on recovery after surgery for idiopathic scoliosis. Spine. 2000;25:2355–2357.
- Gauger V T, Voepel-Lewis T D, Burke C N. et al.Epidural analgesia compared with intravenous analgesia after pediatric posterior spinal fusion. J Pediatr Orthop. 2009;29:588–593.
- Milbrandt T A, Singhal M, Minter C. et al.A comparison of three methods of pain control for posterior spinal fusions in adolescent idiopathic scoliosis. Spine. 2009;34:1499–1503.
- O'Hara J F Jr, Cywinski J B, Tetzlaff J E, Xu M, Gurd A R, Andrish J T. The effect of epidural vs intravenous analgesia for posterior spinal fusion surgery. Paediatr Anaesth. 2004;14:1009–1015.
- Blumenthal S, Borgeat A, Nadig M, Min K. Postoperative analgesia after anterior correction of thoracic scoliosis: a prospective randomized study comparing continuous double epidural catheter technique with intravenous morphine. Spine. 2006;31:1646–1651.
- Karmakar M K, Booker P D, Franks R. Bilateral continuous paravertebral block used for postoperative analgesia in an infant having bilateral thoracotomy. Paediatr Anaesth. 1997;7:469–471.
- Pham Dang C, Delécrin J, Péréon Y. et al.Epidural analgesia after scoliosis surgery: electrophysiologic and clinical assessment of the effects of bupivacaine 0.125% plus morphine versus ropivacaine 0.2% plus morphine. J Clin Anesth. 2008;20:17–24.
- Gall O, Aubineau J-V, Bernière J, Desjeux L, Murat I. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology. 2001;94:447–452.
- Eschertzhuber S, Hohlrieder M, Keller C, Oswald E, Kuehbacher G, Innerhofer P. Comparison of high- and low-dose intrathecal morphine for spinal fusion in children. Br J Anaesth. 2008;100:538–543.
- Tripi P A, Poe-Kochert C, Potzman J, Son-Hing J P, Thompson G H. Intrathecal morphine for postoperative analgesia in patients with idiopathic scoliosis undergoing posterior spinal fusion. Spine. 2008;33:2248–2251.
- Goodarzi M. The advantages of intrathecal opioids for spinal fusion in children. Paediatr Anaesth. 1998;8:131–134.
- Poe-Kochert C, Tripi P A, Potzman J, Son-Hing J P, Thompson G H. Continuous intravenous morphine infusion for postoperative analgesia following posterior spinal fusion for idiopathic scoliosis. Spine. 2010;35:754–757.
- Liu S S, Richman J M, Thirlby R C, Wu C L. Efficacy of continuous wound catheters delivering local anesthetic for postoperative analgesia: a quantitative and qualitative systematic review of randomized controlled trials. J Am Coll Surg. 2006;203:914–932.
- Parvizi J, Miller A G, Gandhi K. Multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am. 2011;93:1075–1084.
- Elder J B, Hoh D J, Wang M Y. Postoperative continuous paravertebral anesthetic infusion for pain control in lumbar spinal fusion surgery. Spine. 2008;33:210–218.
- Baig M K, Zmora O, Derdemezi J, Weiss E G, Nogueras J J, Wexner S D. Use of the ON-Q pain management system is associated with decreased postoperative analgesic requirement: double blind randomized placebo pilot study. J Am Coll Surg. 2006;202:297–305.
- Dadure C, Pirat P, Raux O. et al.Perioperative continuous peripheral nerve blocks with disposable infusion pumps in children: a prospective descriptive study. Anesth Analg. 2003;97:687–690.
- Ross P A, Smith B M, Tolo V T, Khemani R G. Continuous infusion of bupivacaine reduces postoperative morphine use in adolescent idiopathic scoliosis after posterior spine fusion. Spine. 2011;36:1478–1483.
- Yaster M, Lenke L G, Maxwell L G. Philadelphia, PA: Lippincott Williams & Wilkins; 2003. Opioid agonists and antagonists; pp. 181–224.
- McPherson M M. Bethesda, MD: American Society of Health System Pharmacists; 2010. Introduction to opioid conversion calculations; pp. 1–16.
- Rockville, MD: Agency for Health Care Policy and Research; 1992. Dosage tables for adult and pediatric patients; pp. C112–C113.
- Wong D L Hockenberry-Eaton M Wilson D Winkelstein M L Scwartz P Wong's Essentials of Pediatric Nursing. 6th edSt. Louis, MO; 20011301
- Horn P L, Wrona S, Beebe A C, Klamar J E. A retrospective quality improvement study of ketorolac use following spinal fusion in pediatric patients. Orthop Nurs. 2010;29:342–343.
- Suski M, Bujak-Gizycka B, Madej J. et -administration of dextromethorphan and morphine: reduction of post-operative pain and lack of influence on morphine metabolism. Basic Clin Pharmacol Toxicol. 2010;107:680–684.
- Rusy L M, Hainsworth K R, Nelson T J. et al.Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg. 2010;110:1393–1398.
Source: PubMed