Are We Undermedicating Patients With Neuromuscular Scoliosis After Posterior Spinal Fusion?

M Wade Shrader; Mandy N Falk; Richard S Cotugno; John S Jones; Greg R White; Lee S Segal

doi:10.1016/j.jspd.2014.04.012

Are We Undermedicating Patients With Neuromuscular Scoliosis After Posterior Spinal Fusion?

Spine Deform. 2014 Sep;2(5):399-403. doi: 10.1016/j.jspd.2014.04.012. Epub 2014 Aug 27.

Authors

M Wade Shrader¹, Mandy N Falk², Richard S Cotugno², John S Jones², Greg R White², Lee S Segal²

Affiliations

¹ Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA. Electronic address: mwshrader@phoenixchildrens.com.
² Division of Pediatric Orthopaedic Surgery, Phoenix Children's Hospital, 1919 East Thomas Road, Phoenix, AZ 85016, USA.

PMID: 27927339
DOI: 10.1016/j.jspd.2014.04.012

Abstract

Study design: Retrospective, matched study of patients with adolescent idiopathic scoliosis (AIS) and patients with cerebral palsy (CP) undergoing (PSF).

Objectives: To compare pain management, through measurement of the amount of narcotic used and pain scores, for patients with neuromuscular (NM) scoliosis undergoing PSF to a cohort of patients with AIS.

Summary of background data: Posterior spinal fusion for children with severe NM scoliosis carries a high risk of complications. Appropriate assessment of pain is crucial; undertreatment of pain leads to anxiety whereas overtreatment can lead to respiratory depression and additional complications.

Methods: A series of patients with NM scoliosis was matched for age, gender, and weight with a group of patients with AIS. Data collection included age, curve type and magnitude, and instrumentation type and levels fused. The total opioid used (TOU) was determined by summing all narcotics given during the hospital stay and converting them to morphine equivalent units. The data were then analyzed to determine differences in TOU.

Results: A total of 25 patients with NM scoliosis were included in the study. This group was matched with 25 patients with AIS scoliosis. The TOU for the NM group was 1.2 mg morphine/kg (range, 0.28-4.21 mg morphine/kg) whereas the TOU for the AIS group was 3.52 mg morphine/kg (range, 0.71-15.51 mg morphine/kg) (p < .0000001).

Conclusions: In this case-control analysis, patients with AIS undergoing PSF received more than twice the amount of narcotic compared with a matched group of patients with NM scoliosis. These data suggest that NM patients' pain may be undertreated compared with AIS patients. More study is indicated to investigate pain assessment and pain control in this vulnerable patient population to improve care.

Keywords: Cerebral palsy; Idiopathic scoliosis; Pain control; Scoliosis.