Benefits seen with multimodal pain regimen for pediatric patients undergoing spinal fusion
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SAN DIEGO — A multimodal pain regimen decreases total inpatient postoperative opioid use and improves pain scores in patients with adolescent idiopathic scoliosis who undergo posterior spinal fusion, according to a presenter.
“Optimizing perioperative pain management for adolescent idiopathic scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) has been an area of interest for many years, both to improve upon traditional pain management strategies and to minimize opioid-related complications,” Jonathan D. Grabau, MD, said in his presentation at the American Academy of Orthopaedic Surgeons Annual Meeting.
In a retrospective review, Grabau and colleagues analyzed data from 215 patients with AIS who underwent PSF from 2008 to 2019. According to the abstract, 144 patients served as the non-multimodal pain regimen (non-MMPR) control group and 71 patients served as the multimodal pain regimen (MMPR) group.
The non-MMPR group received a patient-controlled analgesia pump, which consisted of either morphine, ketamine and/or hydromorphone, as well as oral acetaminophen and anti-spasmodic agents. The MMPR group received the same medications as the control group with the addition of gabapentin or pregabalin and ketorolac or celecoxib. Outcome measures included total inpatient postoperative opioid consumption in morphine milligram equivalents (MME), VAS pain scores, length of stay (LOS), complications, readmissions and ED visits within 30 days of discharge.
Grabau and colleagues found unadjusted opioid consumption was nearly four times less in the MMPR group (67.4 MME) compared with the non-MMPR group (259.1 MME). Additionally, inpatient postoperative opioid consumption rate, LOS and VAS pain scores were all lower in the MMPR group. No significant differences were found in complication rates, readmissions or ED visits.
“In summary, we have shown that a standard multimodal regimen substantially decreases LOS while also decreasing postoperative opioid use and mean pain scores,” Grabau concluded. “While this study did not directly analyze costs of [opioid] reduction and LOS, it may allow for a decrease in overall cost of surgery for these patients. This is consistent with other literature on the topic and, thus, we would recommend incorporation into practice.”
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Grabau JD, et al. Paper 324. Presented at: American Academy of Orthopaedic Surgeons Annual Meeting; Aug. 31- Sept. 3, 2021; San Diego.
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