Postoperative Ketorolac Does Not Predispose to Pseudoarthrosis Following Posterior Spinal Fusion and Instrumentation for Adolescent Idiopathic Scoliosis

Sucato, Daniel J.; Lovejoy, John F.; Agrawal, Sundeep; Elerson, Emily; Nelson, Trudi; McClung, Anna

doi:10.1097/brs.0b013e31816f6a2a

Cited by 91 publications

(36 citation statements)

References 24 publications

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“…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. 24,25 We found that our pairing of a multimodal pain protocol with early rehabilitation was not associated with an increase in self-reported pain scores, and there is early suggestion that the pain improved on POD 0 and 1. We used self-reported pain scores as both an outcome and a balancing measure.…”

Section: Discussionmentioning

confidence: 84%

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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Section: Discussionmentioning

confidence: 84%

Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis

et al. 2016

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“…The debate is ongoing, but it has recently been demonstrated that ketorolac did not predispose to pseudoarthrosis in an adolescent idiopathic scoliosis surgical population [23]. Likewise, Dodwell et al [24] reviewed NSAID for postoperative pain treatment in seven high-quality retrospective studies in spine surgery and did not find an increased risk of pseudoarthrosis from shortterm NSAID use during a 12-month follow-up period.…”

Section: Discussionmentioning

confidence: 99%

A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery

et al. 2013

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Purpose Major spine surgery with multilevel instrumentation is followed by large amount of opioid consumption, significant pain and difficult mobilization in a population of predominantly chronic pain patients. This case-control study investigated if a standardized comprehensive pain and postoperative nausea and vomiting (PONV) treatment protocol would improve pain treatment in this population. Methods A new regimen with acetaminophen, NSAIDs, gabapentin, S-ketamine, dexamethasone, ondansetron and epidural local anesthetic infusion or patient controlled analgesia with morphine, was introduced in a post-intervention group of 41 consecutive patients undergoing multilevel (median 10) instrumented spinal fusions and compared with 44 patients in a pre-intervention group. Results Compared to patients in the pre-intervention group, patients treated according to the new protocol consumed less opioid on postoperative day (POD) 1 (P = 0.024) and 2 (P = 0.048), they were mobilized earlier from bed (P = 0.003) and ambulation was earlier both with and without a walking frame (P = 0.027 and P = 0.027, respectively). Finally, patients following the new protocol experienced low intensities of nausea, sedation and dizziness on POD 1-6. Conclusions In this study of patients scheduled for multilevel spine surgery, it was demonstrated that compared to a historic group of patients receiving usual care, a comprehensive and standardized multimodal pain and PONV protocol significantly reduced opioid consumption, improved postoperative mobilization and presented concomitant low levels of nausea, sedation and dizziness.

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“…Studies investigating the effect of NSAIDs on spinal fusion also failed to provide conclusive answers, with some studies showing an inhibitory effect toward fusion while others contradict these findings. [72][73][74][75][76] In vitro and animal studies has shown similar variations in outcome. 64,65 The diversity in study design may have contributed to the lack of consensus, but even studies with identical study parameters sometimes report contradictory findings.…”

Section: Nsaidsmentioning

confidence: 94%