title: Evaluation of dexmedetomidine and postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital.
abstract: OBJECTIVE
  This study evaluated the effectiveness of dexmedetomidine in decreasing opioid use in children with adolescent idiopathic scoliosis following posterior spinal fusion surgery at a pediatric tertiary care hospital over the past 10 years.
  
  
  METHODS
  This was a retrospective chart review. Patients were separated into two groups: those that received opioid via patient-controlled analgesia pain therapy alone and those that received opioid via patient-controlled analgesia pain therapy with dexmedetomidine.
  
  
  METHODS
  A tertiary pediatric free-standing hospital. The study focused on care administered in the perioperative period, including the operating room, ICU, and general hospital floor.
  
  
  METHODS
  One hundred sixty-three children with adolescent idiopathic scoliosis.
  
  
  METHODS
  None.
  
  
  RESULTS
  Measurements included patient demographics, American Society of Anesthesiologists Physical Status Classification System, levels of spinal fusion, length of hospital stay, complications, numeric pain scores, opioid requirement, elastomeric pain pump use, length of time until ambulation, adverse effects, and naloxone use. Data were collected through the first 72 hours of the perioperative period. One hundred six patients received opioids via patient-controlled analgesia therapy with dexmedetomidine and 57 received opioids via patient-controlled analgesia alone. Within the groups, there were 46 patients who received local anesthetic infusions via elastomeric pumps in the patient-controlled analgesia with dexmedetomidine group and 16 patients had pumps in the patient-controlled analgesia-alone group. There was no overall difference in postoperative use of morphine (or equivalents) between the two groups. However, the use of elastomeric pain pumps demonstrated a statistically significant decrease in mean overall opioid consumption (42.6 mg vs 63.1 mg, p < 0.001).
  
  
  CONCLUSIONS
  There was no difference in opioid use related to dexmedetomidine on any postoperative day. The only variable showing a significant opioid sparing effect was the use of local anesthetic infusions via elastomeric pumps. Using continuous local anesthetic infusions instead of dexmedetomidine could eliminate the need for ICU admission, require shorter hospital stays, and reduce costs while still providing safe and effective pain control.
authors.affiliation: 1Valley Anesthesiology Consultants, Pediatric Pain Consultants, Phoenix, AZ. 2Division of Pediatric Pain Management, Phoenix Children's Hospital, Phoenix, AZ.
authors.forename: John S
authors.initials: JS
authors.lastname: Jones
authors.forename: Richard E
authors.initials: RE
authors.lastname: Cotugno
authors.forename: Neil Raj
authors.initials: NR
authors.lastname: Singhal
authors.forename: Neha
authors.initials: N
authors.lastname: Soares
authors.forename: Janet
authors.initials: J
authors.lastname: Semenova
authors.forename: Sean
authors.initials: S
authors.lastname: Nebar
authors.forename: Emily J
authors.initials: EJ
authors.lastname: Parke
authors.forename: M Wade
authors.initials: MW
authors.lastname: Shrader
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hotz
mesh_terms: D000293:Adolescent; D016058:Analgesia, Patient-Controlled; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage*; D002648:Child; D003422:Critical Care; D020927:Dexmedetomidine / Q000008:administration & dosage*; D020724:Elastomers; D005260:Female; D006776:Hospitals, Pediatric; D006801:Humans; D007260:Infusion Pumps; D036502:Infusions, Intralesional; D007902:Length of Stay; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D059408:Pain Management / Q000379:methods; D010149:Postoperative Pain / Q000188:drug therapy* / Q000209:etiology; D011108:Polymers; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects; D062606:Tertiary Care Centers
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D020724:Elastomers; D011108:Polymers; C036925:elastomeric polymer; D020927:Dexmedetomidine; D009020:Morphine; D002045:Bupivacaine