Key result
An intra-operative fluid restriction and post-operative pain management bundle was associated with a significant decrease in length of stay (P=0.0131) and daily opioid requirements.
Why the study?
Posterior spinal fusion surgery for adolescent idiopathic scoliosis is associated with a long recovery time and significant opioid exposure.
Does an intra-operative fluid restriction and post-operative pain management bundle reduce length of stay and opioid exposure in adolescent posterior spinal fusion patients?
Cohort (n=44)
Does an intra-operative fluid restriction and post-operative pain management bundle reduce length of stay and opioid exposure in adolescent posterior spinal fusion patients?
p-value: p=0.0131
An intra-operative fluid restriction and non-opioid pain management bundle is associated with reduced length of stay and opioid requirements in adolescents undergoing posterior spinal fusion.
May support fluid-restriction and non-opioid bundles in adolescent spinal fusion; hypothesis-generating and requires randomized confirmation.
Background: Adolescent idiopathic scoliosis (AIS) is best corrected with posterior spinal fusion surgery (PSF) when scoliosis is causing significant pain, inhibiting cardiac or pulmonary function, and/or there is a significant scoliosis curve. However, with such a surgery there is a long recovery time and significant opioid exposure. Methods: This is a retrospective study of 44 patients, ages 11–21, who underwent PSF and recovered in the PICU from June 2011 to November 2019. Eighteen patients were studied prior to the start of the PSF protocol and 26 patients were studied on the PSF protocol. Protocol consisted of restricting intravenous (IV) fluids to goal of 1,500 mL intra-operatively, followed by post-operative pain management to include: ketamine infusion 3–5 mcg/kg/min, scheduled IV acetaminophen every 6 hours, scheduled gabapentin three times a day during post-operative day 1, scheduled ketorolac every 6 hours for post-operative day 1, hydromorphone or morphine PCA without basal rate, and dantrolene or valium for muscle spasticity. Each patient was given isotonic maintenance IV fluids post-operatively. Results: Protocol group compared to pre-protocol group were found to have statistically and clinically significant decrease in their length of stay (P=0.0131), foley removal time (P≤0.001), and time to out of bed (P=0.0002) by about 1 day. The protocol group also required significantly less morphine equivalents of opioid infusion daily (on day 1 P=0.0294, day 2 P=0.0160, and day 3 P=0.0185 post operatively), but no overall significant difference in subjective pain scores (on day 1 shift 1 P=0.0528, shift 2 P=0.3341; day 2 shift 1 P=0.6559, shift 2 P=0.9519; and day 3 shift 1 P=0.0301, shift 2 P=0.141 post operatively). Interestingly, increase of morphine equivalent total was positively correlated to increase length of stay (P=0.0031). There was no change in adverse outcomes between each group (P=0.7631). Conclusions: Based on these results, by restricting intraoperative fluid and using our non-opioid pain management can be associated with a clinically significant reduction in length of stay and opioid requirements.
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Mari et al. (2021) conducted a cohort in Adolescent idiopathic scoliosis (AIS) (n=44). Intra-operative fluid restriction and post-operative pain management bundle vs. Pre-protocol group was evaluated on Length of stay (p=0.0131). An intra-operative fluid restriction and post-operative pain management bundle was associated with a significant decrease in length of stay (P=0.0131) and daily opioid requirements.