Shrader M Wade, Jones John, Falk Mandy N, White Greg R, Burk David R, Segal Lee S
Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA,
J Child Orthop. 2015 Jun;9(3):221-5. doi: 10.1007/s11832-015-0656-x. Epub 2015 May 6.
Concerns about pain control in patients with cerebral palsy (CP) are especially anxiety provoking for parents, given the fact that spasticity, communication issues, and postoperative muscle spasms are significant problems that make pain control difficult in these patients. A better understanding of the magnitude and quality of the pain these patients experience after our surgical procedures would better prepare the patients and their families. The purpose of this study is to quantify the amount of postoperative pain in children with CP undergoing hip reconstruction and spinal fusion. Specifically, the study will compare pain scores and the amount of narcotics used between the two groups.
This is a retrospective chart review of a consecutive series of children with CP (GMFCS levels IV and V) over a 5-year period undergoing hip reconstruction (femoral osteotomy, pelvic osteotomy, or both) and posterior spinal fusion (PSF) at a tertiary-care pediatric hospital. The primary end point was the total opioid used by the patient during the hospitalization, by converting all forms of narcotics to morphine equivalents. The secondary end point was the documentation of pain with standard pain scores at standard time points postoperatively. Adverse effects related to pain management were documented for both groups. Student's t-tests were utilized to statistically compare differences between the groups, with significance determined at p < 0.05.
Forty-two patients with CP who underwent hip reconstruction (mean age 8.8 years) were compared to 26 patients who underwent PSF (mean age 15.4 years). The total opioid used, normalized by body weight and by days length of stay (DLOS), in the hip group was 0.49 mg morphine/kg/DLOS, compared to 0.24 for the spine group (p = 0.014). The mean pain score for the hip group was 1.52, compared to 0.72 for the spine group (p = 0.013). There were no significant differences in the occurrence of adverse effects related to pain management between the two groups.
Patients with CP undergoing hip reconstruction surgery had significantly more pain, as exhibited by requiring more narcotics and having higher pain scores, than those patients undergoing PSF. The knowledge that hip reconstruction is more painful than PSF for patients with CP will better prepare families about what to expect in the postoperative period and will alert providers to supply better postoperative pain control in these patients.
III (case control series).
鉴于痉挛、沟通问题以及术后肌肉痉挛是导致脑瘫（CP）患者疼痛控制困难的重要问题，患儿家长对CP患者的疼痛控制尤为焦虑。更好地了解这些患者在接受手术后所经历疼痛的程度和性质，将有助于患者及其家属做好更充分的准备。本研究的目的是量化接受髋关节重建和脊柱融合手术的CP患儿术后的疼痛程度。具体而言，该研究将比较两组患者的疼痛评分以及使用的麻醉药品数量。
这是一项对一家三级儿科医院5年间连续收治的CP患儿（GMFCS分级为IV级和V级）进行的回顾性图表审查，这些患儿接受了髋关节重建手术（股骨截骨术、骨盆截骨术或两者皆有）以及后路脊柱融合术（PSF）。主要终点是患者住院期间使用的阿片类药物总量，通过将所有形式的麻醉药品换算为吗啡当量来计算。次要终点是术后标准时间点使用标准疼痛评分记录疼痛情况。记录两组与疼痛管理相关的不良反应。采用学生t检验对两组间的差异进行统计学比较，显著性水平设定为p < 0.05。
42例接受髋关节重建手术的CP患者（平均年龄8.8岁）与26例接受PSF手术的患者（平均年龄15.4岁）进行了比较。髋关节组按体重和住院天数（DLOS）标准化后的阿片类药物总用量为0.49毫克吗啡/千克/DLOS，而脊柱组为0.24（p = 0.014）。髋关节组的平均疼痛评分为1.52，而脊柱组为0.72（p = 0.013）。两组在与疼痛管理相关的不良反应发生率方面无显著差异。
接受髋关节重建手术的CP患者比接受PSF手术的患者疼痛明显更严重，表现为需要更多的麻醉药品且疼痛评分更高。了解到髋关节重建手术对CP患者而言比PSF手术更痛苦，将有助于家属更好地了解术后预期情况，并提醒医护人员为这些患者提供更好的术后疼痛控制。
III级（病例对照系列）。
