Management of post-operative pain in children and adolescents with scoliosis
Keywords:
postoperative pain, analgesia, children, adolescents, scoliosisAbstract
Post-operative pain management in children and adolescents undergoing scoliosis surgery remains a major concern. The aim of this study was to review the methods of post-operative pain management in such patients. For this reason, a review of the current literature was performed using the online PUBMED. Inclusion criteria in the review were: prospective, randomized, double-blind studies assessing methods of management of postoperative pain in children and adolescents subjected to spinal surgery due to scoliosis. Twenty-three prospective, randomized, controlled trials were finally included in the review. While intravenous patient-controlled analgesia with morphine remains the gold standard and most widely used analgesia technique for spinal fusion surgery in children and adolescents with scoliosis, other useful methods including epidural analgesia and intrathecal opioids as well as the administration of gabapentin, dexamethasone, acetaminophen and ketorolac seem to have beneficial effects. Taking into consideration the complexity of pain and the high rate of opioid-related adverse events, it is essential to establish a multimodal approach to improve postoperative analgesia.
Downloads
Download data is not yet available.
References
1. Shakil H, Iqbal ZA, Al-Ghadir AH. Scoliosis: review of types of curves, etiological theories and conservative treatment. J Back Musculoskelet Rehabil. 2014;27(2):111-15.
2. Burton MS. Diagnosis and treatment of adolescent idiopathic scoliosis. Pediatr Ann. 2013;42(11):224-28.
3. Bajwa SJ, Haldar R. Pain management following spinal surgeries: An appraisal of the available options. J Craniovertebr Junction Spine. 2015;6(3):105-10.
4. Rullander AC, Jonsson H, Lundström M, Lindh V. Young people’s experiences with scoliosis surgery: a survey of pain, nausea, and global satisfaction. Orthop Nurs. 2013;32(6):327-33.
5. Navarrete-Zampaña MLD, Sellán-Soto MC, Díaz-Martínez ML. Painful experience in adolescents undergoing surgical correction of scoliosis. Enferm Clin. 2019;29(5):297-301.
6. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med. 2002;347(14):1094-103.
7. Palmer GM, Pirakalathanan P, Skinner AV. A multi-centre multi-national survey of anaesthetists regarding the range of anaesthetic and surgical practices for paediatric scoliosis surgery. Anaesth Intensive Care. 2010;38(6):1077-84.
8. Bird S, McGill N. Blood conservation and pain control in scoliosis corrective surgery: an online survey of UK practice. Paediatr Anaesth. 2011;21(1):50-53.
9. Nelson KL, Yaster M, Kost-Byerly S, Monitto CL. A national survey of American Pediatric Anesthesiologists: patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management. Anesth Analg. 2010;110(3):754-60.
10. George JA, Lin EE, Hanna MN, Murphy JD, Kumar K, Ko PS, et al. The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression: a meta-analysis. J Opioid Manag. 2010;6(1):47-54.
11. Hayes J, Dowling JJ, Peliowski A, Crawford MW, Johnston B. Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials. Anesth Analg. 2016;123(4):991-1003.
12. Hiller A, Helenius I, Nurmi E, Neuvonen PJ, Kaukonen M, Hartikainen T, et al. Acetaminophen improves analgesia but does not reduce opioid requirement after major spine surgery in children and adolescents. Spine (Phila Pa 1976). 2012;37(20):E1225-31.
13. Cassady JF, Jr., Lederhaas G, Cancel DD, Cummings RJ, Loveless EA. 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(3):246-53.
14. Gauger VT, Voepel-Lewis TD, Burke CN, Kostrzewa AJ, Caird MS, Wagner DS, et al. Epidural analgesia compared with intravenous analgesia after pediatric posterior spinal fusion. J Pediatr Orthop. 2009;29(6):588-93.
15. Klatt JW, Mickelson J, Hung M, Durcan S, Miller C, Smith JT. A randomized prospective evaluation of 3 techniques of postoperative pain management after posterior spinal instrumentation and fusion. Spine (Phila Pa 1976). 2013;38(19):1626-31.
16. Munro HM, Walton SR, Malviya S, Merkel S, Voepel-Lewis T, Loder RT, et al. Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents. Can J Anaesth. 2002;49(5):461-66.
17. Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, et al. Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg. 2010;110(5):1393-98.
18. Weldon BC, Connor M, White PF. Pediatric PCA: the role of concurrent opioid infusions and nurse-controlled analgesia. Clin J Pain. 1993;9(1):26-33.
19. O’Hara JF, Jr., Cywinski JB, Tetzlaff JE, Xu M, Gurd AR, Andrish JT. The effect of epidural vs intravenous analgesia for posterior spinal fusion surgery. Paediatr Anaesth. 2004;14(12):1009-15.
20. Blumenthal S, Min K, Nadig M, Borgeat A. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology. 2005;102(1):175-80.
21. Erdogan MA, Ozgul U, Ucar M, Korkmaz MF, Aydogan MS, Ozkan AS, et al. Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis: Prospective, Randomized, Double-blinded Study. Spine (Phila Pa 1976). 2017;42(12):882-86.
22. Cohen M, Zuk J, McKay N, Erickson M, Pan Z, Galinkin J. Intrathecal Morphine Versus Extended-Release Epidural Morphine for Postoperative Pain Control in Pediatric Patients Undergoing Posterior Spinal Fusion. Anesth Analg. 2017;124(6):2030-37.
23. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-73.
24. Saudan S, Habre W, Ceroni D, Meyer PA, Greenberg RS, Kaelin A, et al. Safety and efficacy of patient controlled epidural analgesia following pediatric spinal surgery. Paediatr Anaesth. 2008;18(2):132-39.
25. 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(4):538-43.
26. Gall O, Aubineau JV, Bernière J, Desjeux L, Murat I. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology. 2001;94(3):447-52.
27. Goodarzi M. The advantages of intrathecal opioids for spinal fusion in children. Paediatr Anaesth. 1998;8(2):131-34.
28. Tripi PA, Poe-Kochert C, Potzman J, Son-Hing JP, Thompson GH. Intrathecal morphine for postoperative analgesia in patients with idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976). 2008;33(20):2248-51.
29. Engelhardt T, Zaarour C, Naser B, Pehora C, de Ruiter J, Howard A, et al. Intraoperative low-dose ketamine does not prevent a remifentanil-induced increase in morphine requirement after pediatric scoliosis surgery. Anesth Analg. 2008;107(4):1170-75.
30. Minoshima R, Kosugi S, Nishimura D, Ihara N, Seki H, Yamada T, et al. Intra- and postoperative low-dose ketamine for adolescent idiopathic scoliosis surgery: a randomized controlled trial. Acta Anaesthesiol Scand. 2015;59(10):1260-68.
31. Perelló M, Artés D, Pascuets C, Esteban E, Ey Batlle AM. Prolonged Perioperative Low-Dose Ketamine Does Not Improve Short and Long-term Outcomes After Pediatric Idiopathic Scoliosis Surgery. Spine (Phila Pa 1976). 2017;42(5):E304-E12.
32. Pestieau SR, Finkel JC, Junqueira MM, Cheng Y, Lovejoy JF, Wang J, et al. Prolonged perioperative infusion of low-dose ketamine does not alter opioid use after pediatric scoliosis surgery. Paediatr Anaesth. 2014;24(6):582-90.
33. Mayell A, Srinivasan I, Campbell F, Peliowski A. Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial. Paediatr Anaesth. 2014;24(12):1239-44.
34. Anderson DE, Duletzke NT, Pedigo EB, Halsey MF. Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction. Spine Deform. 2020;8(2):177-85.
35. Helenius LL, Oksanen H, Lastikka M, Pajulo O, Löyttyniemi E, Manner T, et al. Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial. J Bone Joint Surg Am. 2020;102(3):205-12.
36. Olbrecht VA, Ding L, Spruance K, Hossain M, Sadhasivam S, Chidambaran V. Intravenous Acetaminophen Reduces Length of Stay Via Mediation of Postoperative Opioid Consumption After Posterior Spinal Fusion in a Pediatric Cohort. Clin J Pain. 2018;34(7):593-99.
37. Reuben SS, Ablett D, Kaye R. High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion. Can J Anaesth. 2005;52(5):506-12.
38. Gobble RM, Hoang HLT, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg. 2014;133(3):741-55.
39. Fletcher ND, Ruska T, Austin TM, Guisse NF, Murphy JS, Bruce RW, Jr. Postoperative Dexamethasone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2020;102(20):1807-13.
2. Burton MS. Diagnosis and treatment of adolescent idiopathic scoliosis. Pediatr Ann. 2013;42(11):224-28.
3. Bajwa SJ, Haldar R. Pain management following spinal surgeries: An appraisal of the available options. J Craniovertebr Junction Spine. 2015;6(3):105-10.
4. Rullander AC, Jonsson H, Lundström M, Lindh V. Young people’s experiences with scoliosis surgery: a survey of pain, nausea, and global satisfaction. Orthop Nurs. 2013;32(6):327-33.
5. Navarrete-Zampaña MLD, Sellán-Soto MC, Díaz-Martínez ML. Painful experience in adolescents undergoing surgical correction of scoliosis. Enferm Clin. 2019;29(5):297-301.
6. Berde CB, Sethna NF. Analgesics for the treatment of pain in children. N Engl J Med. 2002;347(14):1094-103.
7. Palmer GM, Pirakalathanan P, Skinner AV. A multi-centre multi-national survey of anaesthetists regarding the range of anaesthetic and surgical practices for paediatric scoliosis surgery. Anaesth Intensive Care. 2010;38(6):1077-84.
8. Bird S, McGill N. Blood conservation and pain control in scoliosis corrective surgery: an online survey of UK practice. Paediatr Anaesth. 2011;21(1):50-53.
9. Nelson KL, Yaster M, Kost-Byerly S, Monitto CL. A national survey of American Pediatric Anesthesiologists: patient-controlled analgesia and other intravenous opioid therapies in pediatric acute pain management. Anesth Analg. 2010;110(3):754-60.
10. George JA, Lin EE, Hanna MN, Murphy JD, Kumar K, Ko PS, et al. The effect of intravenous opioid patient-controlled analgesia with and without background infusion on respiratory depression: a meta-analysis. J Opioid Manag. 2010;6(1):47-54.
11. Hayes J, Dowling JJ, Peliowski A, Crawford MW, Johnston B. Patient-Controlled Analgesia Plus Background Opioid Infusion for Postoperative Pain in Children: A Systematic Review and Meta-Analysis of Randomized Trials. Anesth Analg. 2016;123(4):991-1003.
12. Hiller A, Helenius I, Nurmi E, Neuvonen PJ, Kaukonen M, Hartikainen T, et al. Acetaminophen improves analgesia but does not reduce opioid requirement after major spine surgery in children and adolescents. Spine (Phila Pa 1976). 2012;37(20):E1225-31.
13. Cassady JF, Jr., Lederhaas G, Cancel DD, Cummings RJ, Loveless EA. 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(3):246-53.
14. Gauger VT, Voepel-Lewis TD, Burke CN, Kostrzewa AJ, Caird MS, Wagner DS, et al. Epidural analgesia compared with intravenous analgesia after pediatric posterior spinal fusion. J Pediatr Orthop. 2009;29(6):588-93.
15. Klatt JW, Mickelson J, Hung M, Durcan S, Miller C, Smith JT. A randomized prospective evaluation of 3 techniques of postoperative pain management after posterior spinal instrumentation and fusion. Spine (Phila Pa 1976). 2013;38(19):1626-31.
16. Munro HM, Walton SR, Malviya S, Merkel S, Voepel-Lewis T, Loder RT, et al. Low-dose ketorolac improves analgesia and reduces morphine requirements following posterior spinal fusion in adolescents. Can J Anaesth. 2002;49(5):461-66.
17. Rusy LM, Hainsworth KR, Nelson TJ, Czarnecki ML, Tassone JC, Thometz JG, et al. Gabapentin use in pediatric spinal fusion patients: a randomized, double-blind, controlled trial. Anesth Analg. 2010;110(5):1393-98.
18. Weldon BC, Connor M, White PF. Pediatric PCA: the role of concurrent opioid infusions and nurse-controlled analgesia. Clin J Pain. 1993;9(1):26-33.
19. O’Hara JF, Jr., Cywinski JB, Tetzlaff JE, Xu M, Gurd AR, Andrish JT. The effect of epidural vs intravenous analgesia for posterior spinal fusion surgery. Paediatr Anaesth. 2004;14(12):1009-15.
20. Blumenthal S, Min K, Nadig M, Borgeat A. Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery. Anesthesiology. 2005;102(1):175-80.
21. Erdogan MA, Ozgul U, Ucar M, Korkmaz MF, Aydogan MS, Ozkan AS, et al. Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis: Prospective, Randomized, Double-blinded Study. Spine (Phila Pa 1976). 2017;42(12):882-86.
22. Cohen M, Zuk J, McKay N, Erickson M, Pan Z, Galinkin J. Intrathecal Morphine Versus Extended-Release Epidural Morphine for Postoperative Pain Control in Pediatric Patients Undergoing Posterior Spinal Fusion. Anesth Analg. 2017;124(6):2030-37.
23. Practice guidelines for acute pain management in the perioperative setting: an updated report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology. 2012;116(2):248-73.
24. Saudan S, Habre W, Ceroni D, Meyer PA, Greenberg RS, Kaelin A, et al. Safety and efficacy of patient controlled epidural analgesia following pediatric spinal surgery. Paediatr Anaesth. 2008;18(2):132-39.
25. 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(4):538-43.
26. Gall O, Aubineau JV, Bernière J, Desjeux L, Murat I. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology. 2001;94(3):447-52.
27. Goodarzi M. The advantages of intrathecal opioids for spinal fusion in children. Paediatr Anaesth. 1998;8(2):131-34.
28. Tripi PA, Poe-Kochert C, Potzman J, Son-Hing JP, Thompson GH. Intrathecal morphine for postoperative analgesia in patients with idiopathic scoliosis undergoing posterior spinal fusion. Spine (Phila Pa 1976). 2008;33(20):2248-51.
29. Engelhardt T, Zaarour C, Naser B, Pehora C, de Ruiter J, Howard A, et al. Intraoperative low-dose ketamine does not prevent a remifentanil-induced increase in morphine requirement after pediatric scoliosis surgery. Anesth Analg. 2008;107(4):1170-75.
30. Minoshima R, Kosugi S, Nishimura D, Ihara N, Seki H, Yamada T, et al. Intra- and postoperative low-dose ketamine for adolescent idiopathic scoliosis surgery: a randomized controlled trial. Acta Anaesthesiol Scand. 2015;59(10):1260-68.
31. Perelló M, Artés D, Pascuets C, Esteban E, Ey Batlle AM. Prolonged Perioperative Low-Dose Ketamine Does Not Improve Short and Long-term Outcomes After Pediatric Idiopathic Scoliosis Surgery. Spine (Phila Pa 1976). 2017;42(5):E304-E12.
32. Pestieau SR, Finkel JC, Junqueira MM, Cheng Y, Lovejoy JF, Wang J, et al. Prolonged perioperative infusion of low-dose ketamine does not alter opioid use after pediatric scoliosis surgery. Paediatr Anaesth. 2014;24(6):582-90.
33. Mayell A, Srinivasan I, Campbell F, Peliowski A. Analgesic effects of gabapentin after scoliosis surgery in children: a randomized controlled trial. Paediatr Anaesth. 2014;24(12):1239-44.
34. Anderson DE, Duletzke NT, Pedigo EB, Halsey MF. Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction. Spine Deform. 2020;8(2):177-85.
35. Helenius LL, Oksanen H, Lastikka M, Pajulo O, Löyttyniemi E, Manner T, et al. Preemptive Pregabalin in Children and Adolescents Undergoing Posterior Instrumented Spinal Fusion: A Double-Blinded, Placebo-Controlled, Randomized Clinical Trial. J Bone Joint Surg Am. 2020;102(3):205-12.
36. Olbrecht VA, Ding L, Spruance K, Hossain M, Sadhasivam S, Chidambaran V. Intravenous Acetaminophen Reduces Length of Stay Via Mediation of Postoperative Opioid Consumption After Posterior Spinal Fusion in a Pediatric Cohort. Clin J Pain. 2018;34(7):593-99.
37. Reuben SS, Ablett D, Kaye R. High dose nonsteroidal anti-inflammatory drugs compromise spinal fusion. Can J Anaesth. 2005;52(5):506-12.
38. Gobble RM, Hoang HLT, Kachniarz B, Orgill DP. Ketorolac does not increase perioperative bleeding: a meta-analysis of randomized controlled trials. Plast Reconstr Surg. 2014;133(3):741-55.
39. Fletcher ND, Ruska T, Austin TM, Guisse NF, Murphy JS, Bruce RW, Jr. Postoperative Dexamethasone Following Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis. J Bone Joint Surg Am. 2020;102(20):1807-13.
Downloads
Published
2021-12-02
Issue
Section
Young Scientists Pages
