Acetaminophen Improves Analgesia but Does Not Reduce Opioid Requirement After Major Spine Surgery in Children and Adolescents

Hiller, Arja; Helenius, Ilkka; Nurmi, Elisa; Neuvonen, Pertti J.; Kaukonen, Maija; Hartikainen, Tuula; Korpela, Reijo; Taivainen, T.; Meretoja, O. A.

doi:10.1097/brs.0b013e318263165c

Cited by 85 publications

(40 citation statements)

References 25 publications

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“…While the use of sedative adjuncts like diazepam may be a confounding factor for oversedation and respiratory depression, 44 use of diazepam did not affect occurrence of MIRD in our cohort, likely because diazepam is not given within two hours of morphine boluses in our practice. Some studies support that intravenous acetaminophen reduces morphine consumption in patients undergoing major surgery, 45 while others do not; 46 in our cohort, the use of acetaminophen did not improve pain scores or the occurrence of MIRD. Use of remi-fentanil infusion had been implicated in the development of opioid-induced hyperalgesia after spine surgery; 47 we did not find an association between remifentanil dose and pain scores.…”

Section: Discussioncontrasting

confidence: 54%

Association of OPRM1 A118G variant with risk of morphine-induced respiratory depression following spine fusion in adolescents

et al. 2014

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The μ1 opioid receptor (OPRM1) genetic variant A118G results in decreased μ-receptor binding potential in the brain and increases morphine requirement. We hypothesized that OPRM1 A118G polymorphism will affect morphine-induced respiratory depression (MIRD) risk in children receiving morphine. A prospective genotype-blinded study was conducted in 88 healthy adolescents (11–18 years; 67% female, 85% Caucasian) who underwent spine fusion for scoliosis. They were followed for 48 h postoperatively for MIRD, pain scores, morphine consumption and use of analgesic adjuvants. Patients were genotyped for OPRM1 A118G variant—76% were wild type (AA) and 24% heterozygous/homozygous for variant (AG/GG). Multivariable logistic regression showed that the risk of MIRD in patients with AA genotype was significantly higher (odds ratio 5.6, 95% CI: 1.4–37.2, P = 0.030). Presence of G allele was associated with higher pain scores (effect size 0.73, P = 0.045). This novel association is an important step toward predicting MIRD susceptibility and personalizing morphine use.

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Section: Discussioncontrasting

confidence: 54%

Association of OPRM1 A118G variant with risk of morphine-induced respiratory depression following spine fusion in adolescents

et al. 2014

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“…15 Intravenous acetaminophen has been proposed as a useful adjuvant in pain management after major orthopedic surgery 8 and, within pediatric PSF patients, intravenous acetaminophen has been shown to improve early pain scores but has no effect on opioid consumption. 16 Ketorolac has been shown to improve analgesia and reduce opioid consumption while reducing both opioid-related gastrointestinal side effects and LOS in general pediatric orthopedic populations 17,18 and pediatric spinal fusion populations. 6 Although some have cautioned against the use of ketorolac in major orthopedic surgery because of concerns about platelet dysfunction and impaired bone healing, 19,20 there is growing evidence that ketorolac is safe in pediatric orthopedic populations [21][22][23] and spinal fusion populations.…”

Section: Discussionmentioning

confidence: 99%

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

et al. 2016

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BACKGROUND: Posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) is associated with significant pain and prolonged hospitalization. There is evidence that early mobilization and multimodal analgesia can accelerate functional recovery and reduced length of stay (LOS). Using these principles, we implemented a quality improvement initiative to enable earlier functional recovery in our AIS–PSF population. METHODS: We designed and implemented a standardized rapid recovery pathway (RRP) with evidence-based management recommendations for children aged 10 to 21 years undergoing PSF for AIS. Our primary outcome, functional recovery, was assessed using statistical process control charts for LOS and average daily pain scores. Our process measures were medication adherence and order set utilization. The balancing measure was 30-day readmission rate. RESULTS: We included 322 patients from January 1, 2011 to June 30, 2015 with 134 (42%) serving as historical controls, 104 (32%) representing our transition population, and 84 (26%) serving as our RRP population. Baseline average LOS was 5.7 days and decreased to 4 days after RRP implementation. Average daily pain scores remained stable with improvement on postoperative day 0 (3.8 vs 4.9 days) and 1 (3.8 vs 5 days) after RRP implementation. In the second quarter of 2015, gabapentin (91%) and ketorolac (95%) use became routine and order set utilization was 100%. Readmission rates did not increase as a result of this pathway. CONCLUSIONS: Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced LOS without an increase in reported pain scores or readmissions.

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“…However, there are also complications of spinal fusion that mainly include wound complications, major medical complications which comprises procedure codes for endotracheal intubation, cardiopulmonary resuscitation, as well as mechanical ventilation, and mortality [9]. Additionally, during the spinal fusion, analgesia scheme such as patient-controlled epidural analgesia (PCEA) and patient-controlled intravenous analgesia (PCIA) are also of importance to relieve the pain of patients [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries

Wang

et al. 2015

Arch Orthop Trauma Surg

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Acetaminophen Improves Analgesia but Does Not Reduce Opioid Requirement After Major Spine Surgery in Children and Adolescents

Abstract: IV-administered acetaminophen 90 mg/kg/day, adjuvant to oxycodone, did improve analgesia, but did not diminish oxycodone consumption during 24 hours after major spine surgery in children and adolescents. All acetaminophen concentrations were in nontoxic levels.

Cited by 85 publications

References 25 publications

Association of OPRM1 A118G variant with risk of morphine-induced respiratory depression following spine fusion in adolescents

Association of OPRM1 A118G variant with risk of morphine-induced respiratory depression following spine fusion in adolescents

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

Comparison of pain relief between patient-controlled epidural analgesia and patient-controlled intravenous analgesia for patients undergoing spinal fusion surgeries

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