Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis

A narrative review

Hiroyuki Seki, Satoshi Ideno, Taiga Ishihara, Koota Watanabe, Morio Matsumoto, Hiroshi Morisaki

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain. Intravenous patient-controlled analgesia with opioids has been the mainstay of postoperative pain management in these patients. However, the use of systemic opioids is sometimes limited by opioid-related side effects, resulting in poor analgesia. To improve pain management while reducing opioid consumption and opioid-related complications, concurrent use of analgesics and analgesic modalities with different mechanisms of action seems to be rational. The efficacy of intrathecal opioids and nonsteroidal anti-inflammatory drugs as components of multimodal analgesia in scoliosis surgery has been well established. However, there is either controversy or insufficient evidence regarding the use of other analgesic methods, such as continuous ketamine infusion, perioperative oral gabapentin, acetaminophen, continuous wound infiltration of local anesthetics, a single dose of systemic dexamethasone, and lidocaine infusion in this patient population. Moreover, appropriate combinations of analgesics have not been established. The aim of this literature review is to provide detailed information of each analgesic technique so that clinicians can make appropriate choices regarding pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.

Original languageEnglish
Article number17
JournalScoliosis and Spinal Disorders
Volume13
Issue number1
DOIs
Publication statusPublished - 2018 Sep 12

Fingerprint

Spinal Fusion
Scoliosis
Pain Management
Postoperative Pain
Opioid Analgesics
Analgesics
Analgesia
Patient-Controlled Analgesia
Wounds and Injuries
Ketamine
Acetaminophen
Lidocaine
Local Anesthetics
Dexamethasone
Anti-Inflammatory Agents
Pharmaceutical Preparations
Population

Keywords

  • Analgesia
  • Pain management
  • Scoliosis
  • Spine surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

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abstract = "Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain. Intravenous patient-controlled analgesia with opioids has been the mainstay of postoperative pain management in these patients. However, the use of systemic opioids is sometimes limited by opioid-related side effects, resulting in poor analgesia. To improve pain management while reducing opioid consumption and opioid-related complications, concurrent use of analgesics and analgesic modalities with different mechanisms of action seems to be rational. The efficacy of intrathecal opioids and nonsteroidal anti-inflammatory drugs as components of multimodal analgesia in scoliosis surgery has been well established. However, there is either controversy or insufficient evidence regarding the use of other analgesic methods, such as continuous ketamine infusion, perioperative oral gabapentin, acetaminophen, continuous wound infiltration of local anesthetics, a single dose of systemic dexamethasone, and lidocaine infusion in this patient population. Moreover, appropriate combinations of analgesics have not been established. The aim of this literature review is to provide detailed information of each analgesic technique so that clinicians can make appropriate choices regarding pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.",
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