Abstract
Purpose
This retrospective cohort study compared postoperative as-needed (PRN) opioid consumption pre and postimplementation of a perioperative multimodal analgesic injection composed of ropivacaine, epinephrine, ketorolac, and morphine in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Secondary outcomes include pain score measurements, time to ambulation, length of stay, blood loss, 90-day complication rate, operating room time, nonopioid medication usage, and total inpatient medication cost before and after the initiation of this practice.
Methods
Consecutive patients weighing ≥ 20 kg who underwent PSF for a primary diagnosis of AIS between January 2017 and December 2020 were included. Data from 2018 were excluded to account for standardization of the practice. Patients treated in 2017 only received PCA. Patients treated in 2019 and 2020 only received the injection. Excluded were patients who had any diagnoses other than AIS, allergies to any of the experimental medications, or who were nonambulatory. Data were analyzed utilizing the two-sample t-test or Chi-squared test as appropriate.
Results
Results of this study show that compared with 47 patients treated postoperatively with patient-controlled analgesia (PCA), 55 patients treated with a multimodal perioperative injection have significantly less consumption of PRN morphine equivalents (0.3 mEq/kg vs. 0.5 mEq/kg; p = 0.02). Furthermore, patients treated with a perioperative injection have significantly higher rates of ambulation on postoperative day 1 compared with those treated with PCA (70.9 vs. 40.4%; p = 0.0023).
Conclusion
Administration of a perioperative injection is effective and should be considered in the perioperative protocol in patients undergoing PSF for AIS.
Level of Evidence
Therapeutic Level III.
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Data availability
The deidentified data that support the findings of this study could be made available from the corresponding author upon reasonable request.
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AMP, SK, KK: Made substantial contributions to the acquisition and interpretation of data, drafted the work, and revised it critically for important intellectual content, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. XC: Made substantial contributions to the analysis and interpretation of data, revised the work critically for important intellectual content, approved the version to be published, and agrees to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. LNR, LLL, WCW, JRS, BWS, DDS, DMK: Made substantial contributions to the conception and design of the work, analysis, and interpretation of data, revised the work critically for important intellectual content, approved the version to be published, and agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
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The authors disclose the following declarations outside of this work. Dr. Warner: unpaid consultant for Sofamor Danek and publishing royalties from Saunders/Mosby-Elsevier and Wolters Kluwer Health; Dr. Sawyer: board/committee member for Children’s Spine Foundation and Pediatric Orthopaedic Society of North America, paid presenter for DePuy, A Johnson & Johnson Company, publishing royalties from Elsevier, and paid consultant for Orthopaediatrics; Dr. Spence: publishing royalties from Elsevier, research support from Orthopaediatrics, and board member for Pediatric Orthopaedic Society of North America; Dr. Kelly: publishing royalties from Elsevier and board/committee member for Pediatric Orthopaedic Society of North America. The authors declare no conflicts of interest.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the institutional review board of University of Tennessee Health Science Center (approval number 11-01362-XP).
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Padgett, A.M., Kapoor, S., Rhodes, L.N. et al. Perioperative multimodal analgesic injection for patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion surgery. Spine Deform 11, 977–984 (2023). https://doi.org/10.1007/s43390-023-00670-5
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DOI: https://doi.org/10.1007/s43390-023-00670-5