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Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial.

Samartzis D, Bow C, Cheung JP, Sham P, Mak KC, Cheung WY, Wong YW, Luk KD, Cheung KM, Lawmin JC - Global Spine J (2015)

Bottom Line: However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A.Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8).No significant differences were noted for the pain scores due to the small sample size.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.

ABSTRACT
Study Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed. Autogenous iliac crest bone graft (ICBG) harvesting remains a common procedure worldwide for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern in patients undergoing spine surgery that affects postoperative functional outcome and consumes health care resources. Previous studies have noted a decrease in pain and postoperative analgesic use with the application of continuous infusion of anesthetic at the ICBG site in comparison with placebo. However, there is lack of evidence addressing the efficacy of continuous anesthetic infusion at the ICBG site in young patients and in particular those with spinal deformity, such as AIS. As such, this parallel, double-blinded, randomized controlled trial addressed the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in patients with AIS during the immediate postoperative period. Methods Participants were randomized into two groups. Group A (control subjects) received 3 mL per hour of saline locally at the ICBG site, and group B (treatment subjects) received a constant rate of infusion of 3 mL per hour of 0.25% levobupivacaine. Both groups received their postoperative intervention for 47 hours. All subjects and outcome assessors were blinded to the type of intervention. Utilizing the visual analog pain scale, pain was assessed at the primary spine surgical site, ICBG site, and contralateral ICBG site. Overall physical pain was assessed by the McGill Pain Questionnaire. The degree of analgesic use and complications were also evaluated. All outcomes were assessed up until the fourth day of the patients' hospitalization following surgery. Results Twelve subjects were recruited (five in group A; seven in group B). No difference was noted at baseline regarding age, weight, height, arm span, sex, curve type, instrumented and fused levels, length of hospitalization, and pain scores between groups. Postoperatively, no difference was noted in surgical site pain between groups (p > 0.05). However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A. Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8). No significant differences were noted for the pain scores due to the small sample size. Conclusions This study is the first with a robust level I study design to assess the efficacy of continuous infusion of analgesia into the ICBG site in young patients with AIS. This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters. This study provides further support of postoperative pain management options for children with spinal deformities.

No MeSH data available.


Related in: MedlinePlus

Flowchart of study recruitment. Abbreviation: ICBG, autogenous iliac crest bone graft.
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FI1500070-1: Flowchart of study recruitment. Abbreviation: ICBG, autogenous iliac crest bone graft.

Mentions: The subjects were randomized into two groups. Group A consisted of control subjects and group B consisted of treatment subjects. Both groups received 5 mL of 0.5% levobupivacaine locally at the ICBG site followed by 1-hour washout of the single bolus injection. The single bolus injection was performed as such to maintain the standard of care that has been traditionally offered at our institute. After the bolus, group A received an infusion of 3 mL of saline solution per hour for 47 hours, and group B received continuous infusion of 0.25% levobupivacaine 3 mL per hour for 47 hours at the posterior iliac crest donor site. All subjects were blinded to the type of intervention they received (Fig. 1). All patients received standardized oral analgesics postoperatively. Paracetamol (1 g) was given four times daily, and 50 mg of oral tramadol was given up to four times daily as needed.


Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial.

Samartzis D, Bow C, Cheung JP, Sham P, Mak KC, Cheung WY, Wong YW, Luk KD, Cheung KM, Lawmin JC - Global Spine J (2015)

Flowchart of study recruitment. Abbreviation: ICBG, autogenous iliac crest bone graft.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4836927&req=5

FI1500070-1: Flowchart of study recruitment. Abbreviation: ICBG, autogenous iliac crest bone graft.
Mentions: The subjects were randomized into two groups. Group A consisted of control subjects and group B consisted of treatment subjects. Both groups received 5 mL of 0.5% levobupivacaine locally at the ICBG site followed by 1-hour washout of the single bolus injection. The single bolus injection was performed as such to maintain the standard of care that has been traditionally offered at our institute. After the bolus, group A received an infusion of 3 mL of saline solution per hour for 47 hours, and group B received continuous infusion of 0.25% levobupivacaine 3 mL per hour for 47 hours at the posterior iliac crest donor site. All subjects were blinded to the type of intervention they received (Fig. 1). All patients received standardized oral analgesics postoperatively. Paracetamol (1 g) was given four times daily, and 50 mg of oral tramadol was given up to four times daily as needed.

Bottom Line: However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A.Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8).No significant differences were noted for the pain scores due to the small sample size.

View Article: PubMed Central - PubMed

Affiliation: Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong, SAR, China.

ABSTRACT
Study Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed. Autogenous iliac crest bone graft (ICBG) harvesting remains a common procedure worldwide for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern in patients undergoing spine surgery that affects postoperative functional outcome and consumes health care resources. Previous studies have noted a decrease in pain and postoperative analgesic use with the application of continuous infusion of anesthetic at the ICBG site in comparison with placebo. However, there is lack of evidence addressing the efficacy of continuous anesthetic infusion at the ICBG site in young patients and in particular those with spinal deformity, such as AIS. As such, this parallel, double-blinded, randomized controlled trial addressed the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in patients with AIS during the immediate postoperative period. Methods Participants were randomized into two groups. Group A (control subjects) received 3 mL per hour of saline locally at the ICBG site, and group B (treatment subjects) received a constant rate of infusion of 3 mL per hour of 0.25% levobupivacaine. Both groups received their postoperative intervention for 47 hours. All subjects and outcome assessors were blinded to the type of intervention. Utilizing the visual analog pain scale, pain was assessed at the primary spine surgical site, ICBG site, and contralateral ICBG site. Overall physical pain was assessed by the McGill Pain Questionnaire. The degree of analgesic use and complications were also evaluated. All outcomes were assessed up until the fourth day of the patients' hospitalization following surgery. Results Twelve subjects were recruited (five in group A; seven in group B). No difference was noted at baseline regarding age, weight, height, arm span, sex, curve type, instrumented and fused levels, length of hospitalization, and pain scores between groups. Postoperatively, no difference was noted in surgical site pain between groups (p > 0.05). However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A. Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8). No significant differences were noted for the pain scores due to the small sample size. Conclusions This study is the first with a robust level I study design to assess the efficacy of continuous infusion of analgesia into the ICBG site in young patients with AIS. This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters. This study provides further support of postoperative pain management options for children with spinal deformities.

No MeSH data available.


Related in: MedlinePlus