title: Adjunctive Pain Control Methods Lower Narcotic Use and Pain Scores for Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion.
abstract: METHODS
  This was a retrospective review of patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion (PSF).
  
  
  OBJECTIVE
  To determine whether the use of adjunctive pain medications (bupivacaine pump, dexmedetomidine, and ketorolac) will reduce the need for opioids, reduce postoperative pain, and shorten length of hospital stay in patients with AIS undergoing PSF.
  
  
  BACKGROUND
  Posterior spinal fusion and instrumentation for AIS can cause significant postoperative pain. Adjunctive pain control modalities, including the use of ketorolac, dexmedetomidine, and subcutaneous bupivacaine pumps, all can lessen the effects of postoperative pain.
  
  
  METHODS
  Retrospective review of adolescents aged 10-18 years with AIS receiving PSF surgery over the past 10 years at a tertiary care children's hospital. All patients with AIS undergoing PSF were included in the study. Patients older than 18 or younger than 10 years and those undergoing PSF for other diagnoses, including neuromuscular scoliosis, congenital scoliosis, and kyphosis, were excluded from the study. Patients' pain was managed postoperatively with adjunctive medications in addition to intravenous and oral opioids. Variables of interest were local anesthetic bupivacaine delivered through a subcutaneous pump, sedative/analgesic dexmedetomidine, and ketorolac. Primary outcomes analyzed were normalized opioid requirement after surgery, visual analog scale (VAS) pain scores, and length of stay in the hospital.
  
  
  RESULTS
  A total of 196 children were analyzed with no significant differences in demographics. Univariate analysis showed that all 3 adjunct medications improved outcomes. A multivariate regression model of the outcomes with respect to the 3 medication variables of interest was built, showing that the bupivacaine pump significantly reduced normalized opioid requirement by 0.98 mg/kg (p = .001) and reduced VAS pain scores by 0.67 points (p = .004). Dexmedetomidine significantly reduced the average VAS pain scores in the first 24 hours by 0.62 points (p = .005).
  
  
  CONCLUSIONS
  Use of the bupivacaine pump provided improved analgesia with lower pain scores, lower opioid requirements, and a lower length of stay.
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA. Electronic address: mwshrader@phoenixchildrens.com.
authors.forename: M
authors.initials: M
authors.lastname: Wade Shrader
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
authors.forename: Sean J
authors.initials: SJ
authors.lastname: Nabar
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
authors.forename: John S
authors.initials: JS
authors.lastname: Jones
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
authors.forename: Miranda
authors.initials: M
authors.lastname: Falk
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Cotugno
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
authors.forename: Greg R
authors.initials: GR
authors.lastname: White
authors.affiliation: Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.
authors.forename: Lee S
authors.initials: LS
authors.lastname: Segal
keywords: Idiopathic scoliosis; Pain; Posterior spinal fusion