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

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

doi:10.1016/j.jspd.2014.04.012

Cited by 6 publications

(2 citation statements)

References 16 publications

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“… 4–7 A case–control analysis revealed that patients able to self-report pain after spinal fusion surgery received more than twice the amount of opioids compared to a matched group of patients with neuromuscular scoliosis. 8 This suggests that patients with IDDs may be undertreated postoperatively compared with patients able to self-report their pain.…”

Section: Introductionmentioning

confidence: 99%

Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery

Ocay

Larche

et al. 2023

Canadian Journal of Pain

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Background Postoperative pain cannot be measured accurately among many children with intellectual and developmental disabilities, resulting in underrecognition or delay in recognition of pain. The Critical-Care Pain Observation Tool (CPOT) is a pain assessment tool that has been widely validated in critically ill and postoperative adults. Aims The objective of this study was to validate the CPOT for use with pediatric patients able to self-report and undergoing posterior spinal fusion surgery. Methods Twenty-four patients (10–18 years old) scheduled to undergo surgery were consented to this repeated-measure, within-subject study. To examine discriminative and criterion validation, CPOT scores and patients’ self-reports of pain intensity were collected prospectively by a bedside rater before, during, and after a nonnociceptive and nociceptive procedure on the day following surgery. Patients’ behavioral reactions were video recorded at the bedside and retrospectively viewed by two independent video raters to examine interrater and intrarater reliability of CPOT scores. Results Discriminative validation was supported with higher CPOT scores during the nociceptive procedure than during the nonnociceptive procedure. Criterion validation was supported with a moderate positive correlation between the CPOT scores and the patients’ self-reported pain intensity during the nociceptive procedure. A CPOT cutoff score of ≥2 was associated with the maximum sensitivity (61.3%) and specificity (94.1%). Reliability analyses revealed poor to moderate agreement between bedside and video raters and moderate to excellent consistency within video raters. Conclusions These findings suggest that the CPOT may be a valid tool to detect pain in pediatric patients in the acute postoperative inpatient care unit after posterior spinal fusion.

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Section: Introductionmentioning

confidence: 99%

Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery

Ocay

Larche

et al. 2023

Canadian Journal of Pain

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“…Mentally impaired children were often unable to express pain verbally. This lack of communication constitutes a risk of underestimating pain in this group of children, shown by Shrader [ 8 ]. He reported that patients with AIS received more than twice the amount of narcotics compared with patients with neuromuscular scoliosis.…”

Section: Discussionmentioning

confidence: 99%

Accelerate postoperative management after scoliosis surgery in healthy and impaired children: intravenous opioid therapy versus epidural therapy

Dinter

Bretschneider

Zwingenberger

et al. 2021

Arch Orthop Trauma Surg

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Purpose Postoperative pain is a major concern following scoliosis surgery. CEA (continuous epidural analgesia) is established in postoperative pain therapy as well as intravenous patient-controlled analgesia (IV-PCA). The purpose of this study was to compare the clinical outcomes of both methods. Methods We retrospectively studied 175 children between 8 and 18 years who were subject to posterior scoliosis correction and fusion. Two main cohorts were formed: CEA with local anesthetic and opioids, and IV-PCA with opioids. Both groups further comprised two sub-cohorts: those who were mentally and/or physically healthy (H; n = 93 vs. n = 30) and those who were impaired (I; n = 26 vs. n = 26). The outcome parameters were the demand for pain medication, parameters of mobilization, and the presence of adverse reactions. Results Healthy children who received CEA started mobilization 1 day earlier than children with IV-PCA (p = 0.002). First postsurgical defecation was seen earlier in all children who received CEA in both groups (H; Day 4 vs. Day 5, p = 0.011, I; Day 3 vs. Day 5, p = 0.044). Healthy children who received CEA were discharged from hospital 4 days earlier than their IV-PCA counterparts (p < 0.001). No statistically significant difference in postoperative nausea nor in vomiting was identified between groups. Transient neurological irritations were seen in 9.7% of the patients in the CEA group. Conclusions CEA provides appropriate pain management after scoliosis surgery, regardless of the patient’s mental status. It allows earlier postoperative defecation for all patients , as well as shorter hospitalization and an earlier mobilization for healthy patients.

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Orthopedic Spine Surgery for Patients with Cerebral Palsy

Nahm

Shrader

Matsumoto

et al. 2020

Orthopedic Care of Patients With Cerebral Palsy

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

Cited by 6 publications

References 16 publications

Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery

Validation of the Critical-Care Pain Observation Tool (CPOT) in pediatric patients undergoing orthopedic surgery

Accelerate postoperative management after scoliosis surgery in healthy and impaired children: intravenous opioid therapy versus epidural therapy

Orthopedic Spine Surgery for Patients with Cerebral Palsy

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