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

OBJECTIVES:

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.

DESIGN:

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.

SETTING:

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.

PATIENTS:

One hundred sixty-three children with adolescent idiopathic scoliosis.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN 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: John S Jones, Richard E Cotugno, Neil Raj Singhal, Neha Soares, Janet Semenova, Sean Nebar, Emily J Parke, M Wade Shrader, Jeffrey Hotz
• Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med) Vol. 15 Issue 6 Pg. e247-52 (Jul 2014) ISSN: 1529-7535 [Print] United States
• PMID: 24743445 (Publication Type: Journal Article)

Chemical References

• Analgesics, Non-Narcotic
• Analgesics, Opioid
• Anesthetics, Local
• Elastomers
• Polymers
• elastomeric polymer
• Dexmedetomidine
• Morphine
• Bupivacaine

Topics

• Adolescent
• Analgesia, Patient-Controlled
• Analgesics, Non-Narcotic (administration & dosage)
• Analgesics, Opioid (administration & dosage)
• Anesthetics, Local (administration & dosage)
• Bupivacaine (administration & dosage)
• Child
• Critical Care
• Dexmedetomidine (administration & dosage)
• Elastomers
• Female
• Hospitals, Pediatric
• Humans
• Infusion Pumps
• Infusions, Intralesional
• Length of Stay
• Male
• Morphine (administration & dosage)
• Pain Management (methods)
• Pain, Postoperative (drug therapy, etiology)
• Polymers
• Retrospective Studies
• Scoliosis (surgery)
• Spinal Fusion (adverse effects)
• Tertiary Care Centers