title: Opioid consumption and bowel dysfunction in adolescents after spinal surgery.
abstract: The study, outlined in this article, aimed to ascertain the effect of length of surgery and opioid consumption on length of stay and bowel dysfunction, and to review current post-operative bowel practices. A retrospective case note review was carried out of all patients with a diagnosis of adolescent idiopathic scoliosis (n=44) who had undergone a posterior spinal fusion between January 2012 and May 2014. Mean length of surgery was 3:24 hours (±0:40 hours), while average length of stay was 6 days (mean 6.27 days ±2.39). Average opioid consumption post-operatively was 152.15mg (±60.95mg). There were no statistically significant associations. Some form of laxative was received by 93% of (n=41) patients. Of those, 20 required an enema before discharge. This was most commonly administered on post-operative days four and five (65%). This service evaluation demonstrated that length of surgery and amount of opioid have no significant effect on length of stay for young people following a posterior spinal fusion. It is suggested that lactulose and senna are given in combination at doses as per the British National Formulary for Children starting on post-operative day two, which should avoid the need to administer an enema.
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London.
authors.forename: Thomas
authors.initials: T
authors.lastname: James
authors.affiliation: Great Ormond Street Hospital for Children NHS Foundation Trust, London.
authors.forename: Nathan
authors.initials: N
authors.lastname: Askew
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects*; D002648:Child; D015331:Cohort Studies; D003248:Constipation / Q000139:chemically induced* / Q000628:therapy; D004733:Enema; D005260:Female; D006801:Humans; D007792:Lactulose / Q000627:therapeutic use; D054368:Laxatives / Q000627:therapeutic use; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D061646:Operative Time; D010149:Postoperative Pain / Q000188:drug therapy*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D012676:Senna Extract / Q000627:therapeutic use; D000081226:Sennosides; D013123:Spinal Fusion; D013131:Spine / Q000601:surgery; D062606:Tertiary Care Centers
chemical_list: D000701:Analgesics, Opioid; D054368:Laxatives; D000081226:Sennosides; D007792:Lactulose; D012676:Senna Extract
keywords: adolescents; child health; clinical audit; constipation; opioids; paediatrics; spinal surgery