Prospective Opioid-Free AIS Fusion

Opioids are the most common controlled medication used medically and non-medically by adolescents in the United States. Opioid prescribing practices are inextricably linked with the ongoing public health crisis of opioid misuse in the peri-adolescent population. However, the immediate postoperative period following instrumented posterior spinal fusion (PSF) for idiopathic scoliosis represents a difficult challenge for patients and surgeons alike - particularly with regard to pain control. Opioid medications are commonly used to manage early postoperative pain in these patients, though are associated with potentially deleterious effects and remain at the center of a national health crisis. In particular for peri-adolescent patients, opioids are known to disrupt central nervous system maturation, which may lead to long-term behavioral dysfunction, including increased vulnerability to addiction in adulthood. On the other hand, it is well-recognized that inadequate pain control is associated with atelectasis, delayed mobilization, protracted hospitalization, and increased complication rates following posterior instrumented PSF for idiopathic scoliosis. Consequently, there is a rising, unmet need to develop postoperative recovery pathways for this population, aimed at efficient and safe pain management that minimizes or eliminates opioids while ensuring a positive postoperative experience for the patient.

Previous studies in adult and pediatric patients have compared traditional opioid-based pain regimens to opioid-sparing regimens in the perioperative period, but have been limited by high rates of crossover, retrospective designs, reliance on indwelling pain catheters, reliance on opioids for early postoperative analgesia, and/or lack of patient-reported outcomes. While there are growing efforts to investigate and adopt opioid-free (OF) protocols in adult orthopaedic patients, such protocols have yet to be thoroughly evaluated in the pediatric population. A prior study approved and completed (Protocol# PED032) by Dr. Michael Paloski and team demonstrated that a comprehensive, multimodal, OF pain management pathway following instrumented PSF for idiopathic scoliosis results in equivalent length of stay and fewer opioids prescribed at discharge compared with a traditional opioid-containing (OC) pathway. To our knowledge, this was the first study to show that completely OF postoperative pain management is possible in this population. Additional studies, including the study proposed here, are necessary to evaluate patient-reported outcomes in this population when OF pain management is utilized and to delineate patient-specific and procedure-specific details that may predict success with an OF regimen.

• Morphine milliequivalents (MME) [Срок оценки: Perioperative/Periprocedural]
• Length of hospital stay [Срок оценки: Perioperative/Periprocedural]
• opioid medication prescribed [Срок оценки: Perioperative/Periprocedural]
• Clinic phone calls regarding uncontrolled pain [Срок оценки: Through study completion, an average of 1 year]
• Delayed opioid prescriptions sent [Срок оценки: Through study completion, an average of 1 year]
• Opioid refills requested or sent [Срок оценки: Through study completion, an average of 1 year]
• Unplanned emergency department or clinic visits for pain [Срок оценки: Through study completion, an average of 1 year]
• Days missed from school [Срок оценки: Through study completion, an average of 1 year]
• symptomatic pseudoarthrosis [Срок оценки: Through study completion, an average of 1 year]
• Numeric Pain Rating Scale (NPRS) - Patient [Срок оценки: Through study completion, an average of 1 year]
• Perceived Numeric Pain Rating Scale (NPRS) - Parent/Guardian [Срок оценки: Through study completion, an average of 1 year]
• Patient Acceptable Symptom State (PASS) (patient) [Срок оценки: Through study completion, an average of 1 year]