52. Pre-emptive opioid-sparing medication protocol decreases pain and length of hospital stay in children undergoing posterior spinal instrumented fusion for scoliosis

Abstract

BACKGROUND CONTEXT Poorly controlled postoperative pain following posterior spinal instrumented fusion (PSIF) for scoliosis may be associated with delayed ambulation and longer hospital stays. Multimodal analgesia use has been shown to provide superior analgesia with improved recovery in other orthopedic subspecialities, but has not been described with pediatric patients undergoing spinal surgery. We describe a novel, pre-emptive, opioid-sparing pain medication protocol that is started 2 days prior to surgery, in accordance with first-order pharmacokinetics, and continued postoperatively until discharge with the goal of decreasing postoperative pain, improving mobilization, and decreasing the patient's length of hospital stay. PURPOSE The purpose of this study was to determine if adequate blood concentrations of non-opioid analgesia prior to surgery can decrease the total amount and duration of opioids used postoperatively, while providing optimal pain control. STUDY DESIGN/SETTING Single institution retrospective chart review. PATIENT SAMPLE Patients who had undergone PSIF from March 2014 to November 2017. OUTCOME MEASURES Variables analyzed between both groups were length of hospital stay, total opioid consumption and maximum pain scores per day from surgical discharge date. METHODS We retrospectively reviewed 116 PSIF cases from March 2014 to November 2017. Fifty-two patients received standard analgesia, and 64 patients received the pre-emptive protocol consisting of a standardized combination of acetaminophen, celecoxib, and gabapentin 2 days prior to surgery and continued during their inpatient stay. Scheduled oxycodone and intravenous hydromorphone via patient controlled analgesia (PCA) were given to both groups equally during their hosptial stays. We analyzed legth of stay, total opioid consumption, and maximum pain scores per day from surgical to discharge date. RESULTS Length of hospital stay significantly differed, with means of 3.9 days in the pre-emptive group and 4.5 days in the standard analgesia group (p CONCLUSIONS This is a preliminary report demonstrating a significant decrease in maximal pain score and length of stay following PSIF on a cohort of patients receiving a novel pre-emptive opioid-sparing pain medication protocol. Future studies should investigate degrees of mobilization and opioid consumption and pain levels after discharge from the hospital. FDA DEVICE/DRUG STATUS Univailable from authors at time of publication.