Our Summary

This research paper discusses how to manage pain in teenagers with a certain type of spine curvature (adolescent idiopathic scoliosis) who are going through a specific type of spine surgery. There are many ways to manage this pain, like using special techniques after surgery, spinal drugs, a drug called methadone, or numbing the area where the surgery was done. One new technique uses ultrasound to guide a specific type of pain block in the spine, which is considered safe, easy to do, and could reduce the need for opiate-based painkillers.

There’s also a new long-lasting numbing drug, called Liposomal bupivacaine, which is approved for use in kids aged 6 and older. This drug could be useful if used with the ultrasound-guided technique in patients going through this type of spine surgery because it can provide long-lasting pain relief from just one injection.

The researchers looked at two patients who had this treatment and compared them to 13 other patients who had the same surgery but were given the drug methadone instead. The two patients who had the ultrasound-guided technique seemed to use fewer opiate-based painkillers and left the hospital faster, but they had slightly higher pain scores. However, the study needs more participants to be able to draw any meaningful conclusions. Future larger studies are needed to see if these results hold true.

FAQs

  1. What analgesic techniques are currently used for pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion?
  2. What is ultrasound-guided erector spinae plane blockade (ESPB) and how does it benefit patients with AIS undergoing spinal fusion surgery?
  3. What is liposomal bupivacaine and how can it be beneficial for pain management in pediatric patients undergoing scoliosis surgery?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pediatric scoliosis surgery is to inquire about the use of ultrasound-guided erector spinae plane blockade (ESPB) for pain management. This technique has been shown to be effective in providing prolonged analgesia and reducing opioid use after surgery. It may be a good option to consider for better pain control and faster recovery.

Suitable For

Patients who are typically recommended pediatric scoliosis surgery are those with adolescent idiopathic scoliosis (AIS) who have significant spinal curvature that is causing pain, functional limitations, or respiratory issues. These patients may have tried conservative treatment options such as bracing or physical therapy without success. Additionally, patients who have progressive scoliosis that is likely to worsen over time may also be recommended for surgery to prevent further spinal deformity.

In the case report mentioned above, patients with AIS undergoing posterior spinal fusion surgery were considered for ultrasound-guided erector spinae plane blockade (ESPB) as a method of pain management. This technique, along with other analgesic strategies, can help improve pain control and reduce opioid use in these patients postoperatively. Ultimately, the decision to recommend surgery for pediatric scoliosis patients is made on a case-by-case basis by a multidisciplinary team of healthcare providers including orthopedic surgeons, physical therapists, and pain management specialists.

Timeline

  • Before surgery:
  1. Patient is diagnosed with adolescent idiopathic scoliosis (AIS) and is recommended for posterior spinal fusion surgery.
  2. Patient and family meet with the surgical team to discuss the procedure, risks, and benefits.
  3. Pre-operative testing and imaging are done to assess the extent of the scoliosis and plan for surgery.
  4. Patient may undergo pre-operative physical therapy and education on post-operative care.
  5. Anesthesia team discusses pain management options with the patient and family.
  • After surgery:
  1. Patient undergoes posterior spinal fusion surgery for AIS.
  2. Patient is monitored in the recovery room and then transferred to a hospital room for post-operative care.
  3. Pain management plan is implemented, which may include opioid medications, NSAIDs, muscle relaxants, and local anesthetic infiltration.
  4. Physical therapy and mobility exercises are started to help with recovery and prevent complications.
  5. Patient is monitored for complications such as wound infection, respiratory issues, and nerve damage.
  6. Once pain is controlled and patient is able to tolerate oral intake and mobilize safely, they are discharged home.
  7. Follow-up appointments are scheduled with the surgical team to monitor healing and progress.

What to Ask Your Doctor

  1. What is the success rate of pediatric scoliosis surgery in treating the condition?

  2. What are the potential risks and complications associated with pediatric scoliosis surgery?

  3. How long is the recovery process typically for pediatric scoliosis surgery?

  4. What type of pain management options are available for pediatric scoliosis surgery, and which one do you recommend?

  5. How long can the pain relief from the chosen pain management option be expected to last?

  6. Are there any long-term effects or complications associated with the chosen pain management option?

  7. Will physical therapy be necessary after pediatric scoliosis surgery, and if so, what does it entail?

  8. What are the expected outcomes and prognosis for a child undergoing pediatric scoliosis surgery?

  9. Are there any lifestyle changes or restrictions that the child will need to follow post-surgery?

  10. Are there any alternative treatment options to consider before proceeding with pediatric scoliosis surgery?

Reference

Authors: Stondell C, Roberto R. Journal: J Am Acad Orthop Surg Glob Res Rev. 2022 Jan 21;6(1):e21.00272. doi: 10.5435/JAAOSGlobal-D-21-00272. PMID: 35061632