Wellstar Kennestone Hospital, Graduate Medical Education, Marietta, GA.
Department of Pediatric Orthopedics, Wellstar Health System, Marietta, GA.
Spine (Phila Pa 1976). 2023 Nov 1;48(21):1486-1491. doi: 10.1097/BRS.0000000000004747. Epub 2023 Jun 9.
Retrospective cohort study.
This project aims to evaluate the relationship between increased use of intraoperative nonopioid analgesics, muscle relaxers, and anesthetics and postoperative outcomes, including opioid utilization, time until ambulation, and hospital length of stay.
Adolescent idiopathic scoliosis (AIS) is a structural deformity of the spine that occurs in otherwise healthy adolescents, occurring with a frequency of 1% to 3%. Up to 60% of patients receiving spinal surgeries, particularly posterior spinal fusion (PSF), experience at least 1 day of moderate-to-severe pain after surgery.
This is a retrospective chart review of pediatric patients aged 10 to 17 having received PSF with >5 levels fused for AIS at a dedicated children's hospital and a regional tertiary referral center with a dedicated pediatric spine program between January 2018 and September 2022. A linear regression model was used to evaluate the influence of baseline characteristics and intraoperative medications on the total amount of postoperative morphine milligram equivalents received.
There were no significant differences in the background characteristics of the two patient populations. Patients receiving PSF at the tertiary referral center received equivalent or greater amounts of all nonopioid pain medications and demonstrated decreased time until ambulation (19.3 vs . 22.3 h), postoperative opioid use (56.1 vs . 70.1 MME), and postoperative hospital length of stay (35.9 vs . 58.3 h). Hospital location was not individually associated with a difference in postoperative opioid use. There was not a significant difference in postoperative pain ratings. When accounting for all other variables, liposomal bupivacaine had the greatest contribution to the decrease in postoperative opioid use.
Patients receiving greater amounts of nonopioid intraoperative medications utilized 20% fewer postoperative morphine milligram equivalents, were discharged 22.3 hours earlier and had earlier recorded evidence of mobility. Postoperatively, nonopioid analgesics were as effective as opioids in the reduction of subjective pain ratings. This study further demonstrates the efficacy of multimodal pain management regimens in pediatric patients receiving PSF for AIS.
回顾性队列研究。
本项目旨在评估术中非阿片类镇痛药、肌肉松弛剂和麻醉剂使用量的增加与术后结果之间的关系，包括阿片类药物的使用、下床活动时间和住院时间。
青少年特发性脊柱侧凸（AIS）是一种发生在健康青少年中的脊柱结构性畸形，发生率为 1%至 3%。多达 60%接受脊柱手术的患者，特别是后路脊柱融合术（PSF），术后至少有 1 天经历中度至重度疼痛。
这是一项回顾性图表研究，纳入了在 2018 年 1 月至 2022 年 9 月期间，在一家专门的儿童医院和一家设有专门儿科脊柱项目的地区三级转诊中心接受 PSF 治疗且融合节段数超过 5 个的 10 至 17 岁青少年特发性脊柱侧凸患者。使用线性回归模型评估基线特征和术中药物对术后吗啡毫克当量总量的影响。
两组患者的背景特征无显著差异。在三级转诊中心接受 PSF 的患者接受了等量或更多的所有非阿片类止痛药，且下床活动时间（19.3 小时 vs. 22.3 小时）、术后阿片类药物使用量（56.1 毫克吗啡当量 vs. 70.1 毫克吗啡当量）和术后住院时间（35.9 小时 vs. 58.3 小时）均缩短。医院位置与术后阿片类药物使用量无差异。术后疼痛评分无显著差异。当考虑所有其他变量时，脂质体布比卡因对术后阿片类药物使用量的减少贡献最大。
接受更多术中非阿片类药物治疗的患者术后吗啡毫克当量用量减少 20%，出院时间提前 22.3 小时，更早记录到活动能力。术后，非阿片类镇痛药在减轻主观疼痛评分方面与阿片类药物同样有效。本研究进一步证明了多模式疼痛管理方案在接受 PSF 治疗青少年特发性脊柱侧凸的患者中的疗效。
