Multimodal Perioperative Pharmacological Protocol in Pediatric Spine Surgery
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Published:
Dec 31, 2022
Keywords:
Spine surgery, pediatrics, post-operative pain, multimodal analgesia
Main Article Content
Abstract
Introduction: Spine surgery has one of the highest morbimortality rates in the pediatric population. Pain management has not been standardized on said population. Multimodal analgesia (MMA) was developed to resolve that problem.
Objective: To develop, based on a systematic review, a detailed and original pain management multimodal pharmacology protocol for pre and postoperative (intra and extra-hospital) periods for the pediatric population undergoing spine surgery.
Materials and Methods: We conducted a systematic review of full texts in English and Spanish from PubMed, Embase, Cochrane Library, and LiLacs Database from 2000 to 2021. We used the PRISMA flow diagram.
Results: From a total of 756 papers, 38 were included in the final evaluation. Considering the bioethical difficulties to develop a manuscript from clinical trials with drugs and drug combinations in the pediatric population, we developed an original and detailed pain management protocol for pre and post-operative (intra and extrahospital) periods for the pediatric population undergoing spine surgery.
Conclusion: Based on a systematic review, we succeeded in developing a simple and easily reproducible perioperative multimodal pain management protocol (intra and extra-hospital), intending to expedite the patient’s functional recovery and reduce global socioeconomic costs.Level of Evidence: II
Objective: To develop, based on a systematic review, a detailed and original pain management multimodal pharmacology protocol for pre and postoperative (intra and extra-hospital) periods for the pediatric population undergoing spine surgery.
Materials and Methods: We conducted a systematic review of full texts in English and Spanish from PubMed, Embase, Cochrane Library, and LiLacs Database from 2000 to 2021. We used the PRISMA flow diagram.
Results: From a total of 756 papers, 38 were included in the final evaluation. Considering the bioethical difficulties to develop a manuscript from clinical trials with drugs and drug combinations in the pediatric population, we developed an original and detailed pain management protocol for pre and post-operative (intra and extrahospital) periods for the pediatric population undergoing spine surgery.
Conclusion: Based on a systematic review, we succeeded in developing a simple and easily reproducible perioperative multimodal pain management protocol (intra and extra-hospital), intending to expedite the patient’s functional recovery and reduce global socioeconomic costs.Level of Evidence: II
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Piantoni, L., Tello, C. A., Remondino, R. G., Galaretto, E., & Noel, M. A. (2022). Multimodal Perioperative Pharmacological Protocol in Pediatric Spine Surgery. Revista De La Asociación Argentina De Ortopedia Y Traumatología, 87(6), 825-837. https://doi.org/10.15417/issn.1852-7434.2022.87.6.1490
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References
1. Milbrandt TA, Singhal M, Minter C, McClung A, Talwalkar VR, Iwinski HJ, et al. A comparison of three methods of pain control for posterior spinal fusions in adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2009;34(14):1499-503. https://doi.org/10.1097/BRS.0b013e3181a90ceb
2. Walker CT, Gullotti DM, Prendergast V, Radosevich J, Grimm D, Cole TS, et al. Implementation of standardized
multimodal postoperative analgesia protocol improves pain control, reduces opioid consumption, and shortens
length of hospital stay after posterior lumbar spinal fusion. Neurosurgery 2020;87(1):130-6. https://doi.org/10.1093/neuros/nyz312
3. Cozowicz C, Bekeris J, Poeran J, Zubizarreta N, Schwenk E, Girardi F, et al. Multimodal pain management and
postoperative outcomes in lumbar spine fusion surgery: A population-based cohort study. Spine (Phila Pa 1976)
2020;45(9):580-9. https://doi.org/10.1097/BRS.0000000000003320
4. Piantoni L, Tello CA, Francheri Wilson IA, Remondino R, Galaretto E, et al. Manejo del dolor posoperatorio
por cirugía de columna en la población pediátrica. Resultados preliminares. Rev Asoc Argent Ortop Traumatol
2019;84(3):224-35. https//doi.org/10.15417/issn.1852-7434.2019.84.3.9314
5. Yousefifard M, Askarian-Amiri S, Madani Neishaboori A, Sadeghi M, Saberian P, Baratloo A. Pre-hospital pain
management; a systematic review of proposed guidelines. Arch Acad Emerg Med 2019;7(1):e55. PMID: 31875209
6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CWC, Chenot JF, et al. Clinical practice guidelines for the
management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018;27(11):2791-
803. https://doi.org/10.1007/s00586-018-5673-2
7. Hsu JR, Mir H, Wally MK, Seymour RB. Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical practice guidelines for pain management in acute musculoskeletal injury. J Orthop Trauma 2019;33(5):e158-e182. https://doi.org/10.1097/BOT.0000000000001430
8. Aubrun F, Nouette-Gaulain K, Fletcher D, Belbachir A, Beloeil H, Carles M, et al. Revision of expert panel’s
guidelines on postoperative pain management. Anaesth Crit Care Pain Med 2019;38(4):405-11. https://doi.org/10.1016/j.accpm.2019.02.011
9. Shah SA, Guidry R, Kumar A, White T, King A, Heffernan MJ. Current trends in pediatric spine deformity surgery: multimodal pain management and rapid recovery. Global Spine J 2020;10(3):346-52. https://doi.org/10.1177/2192568219858308
10. Sheffer BW, Kelly DM, Rhodes LN, Sawyer JR. Perioperative pain management in pediatric spine surgery. Orthop Clin North Am 2017;48(4):481-6. https://doi.org/10.1016/j.ocl.2017.06.004
11. Johnson MA, Andras LM, Andras LE, Ellington MD, Upasani VV, Shah AS. What’s new in pain management for
pediatric orthopaedic surgery. J Pediatr Orthop 2021;41(10):e923-3928. https://doi.org/10.1097/BPO.0000000000001956
12. Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol
2008;21(3):313-6. https://doi.org/10.1097/ACO.0b013e3282f82baa
13. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012;116:248–273.
https://doi.org/10.1097/ALN.0b013e31823c1030
14. Aoki Y, Iwata H, Akinaga C, Shiko Y, Kawasaki Y, Kobayashi K, et al. Intraoperative remifentanil dosage in surgery for adolescent idiopathic scoliosis does not increase postoperative opioid consumption when combined with epidural analgesia: A retrospective cohort study. Cureus 2021;13(8):e17361. https://doi.org/10.7759/cureus.17361
15. Bean BA, Connor PM, Schiffern SC, Hamid N. Outpatient shoulder arthroplasty at an ambulatory surgery center using a multimodal pain management approach J Am Acad Orthop Surg Glob Res Rev 2018;2:e064.
https://doi.org/10.5435/JAAOSGlobal-D-18-00064
16. Creary SE, Chisolm DJ, Wrona SK, Cooper JN. Opioid prescription filling trends among children with sickle cell
disease after the release of state-issued guidelines on pain management. Pain Med 2020;21(10):2583-92.
https://doi.org/10.1093/pm/pnaa002
17. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin
Anaesthesiol 2019;33(3):259-67. https://doi.org/10.1016/j.bpa.2019.07.016
18. Joshi GP, Kehlet H; PROSPECT Working Group. Guidelines for perioperative pain management: need for reevaluation. Br J Anaesth 2017;119(4):703-6. https://doi.org/10.1093/bja/aex304
19. Jones JS, Cotugno RE, Singhal NR, Soares N, Semenova J, Nebar S, et al. Evaluation of dexmedetomidine and
postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital. Pediatr Crit Care Med 2014;15(6):e247-52.
https://doi.org/10.1097/PCC.0000000000000119
20. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol 2016;33(3):160-71.
https://doi.org/10.1097/EJA.0000000000000366
21. Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med 2020;29(3):365-74. https://doi.org/10.17219/acem/112600
22. McNicol ED, Rowe E, Cooper TE. Ketorolac for postoperative pain in children. Cochrane Database Syst Rev
2018;7(7):CD012294. https://doi.org/10.1002/14651858.CD012294.pub2
23. Yoo JS, Ahn J, Buvanendran A, Singh K. Multimodal analgesia in pain management after spine surgery. J Spine
Surg 2019;5(2):S154-9. https://doi.org/10.21037/jss.2019.05.04
24. Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, et al. Comparison of perioperative oral
multimodal analgesia versus IV PCA for spine surgery. J Spinal Disord Tech 2010;23(2):139-45.
https://doi.org/10.1097/BSD.0b013e3181cf07ee
25. Rao KE, Krodel D, Toaz EE, Fanelli J, Hajduk J, Kato K, et al. Introduction of an enhanced recovery pathway
results in decreased length of stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: A description of implementation strategies and retrospective before-and-after study of outcomes. J Clin Anesth 2021;75:110493. https://doi.org/10.1016/j.jclinane.2021.110493
26. YaDeau JT, Dines DM, Liu SS, Gordon MA, Goytizolo EA, Lin Y, et al. What pain levels do TSA patients
experience when given a long-acting nerve block and multimodal analgesia? Clin Orthop Relat Res 2019;477:622-
32. https://doi.org/10.1097/CORR.0000000000000597
27. Pagnotto MR, Pagnano MW. Multimodal pain management with peripheral nerve blocks for total knee arthroplasty. Instr Course Lect 2012;61:389-95. PMID: 22301247
28. Li WT, Bell KL, Yayac M, Barmann JA, Star AM, Austin MS. A postdischarge multimodal pain management
cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: A grouprandomized trial. J Arthroplasty 2021;(36) 164e172. https://doi.org/10.1016/j.arth.2020.07.060
29. Karam JA, Schwenk ES, Parvizi J. An update on multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2021;103:1652-62. https://doi.org/10.2106/JBJS.19.01423
30. Anderson DE, Duletzke NT, Pedigo EB, Halsey MF. Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction. Spine Deform 2020;8(2):177-85. https://doi.org/ 10.1007/s43390-020-00038-z
31. Muhly WT, Beltran RJ, Bielsky A, Bryskin RB, Chinn C, Choudhry DK, et al. Perioperative management and
in-hospital outcomes after minimally invasive repair of pectus excavatum: a multicenter registry report from the
society for pediatric anesthesia improvement network. Anesth Analg 2019;128(2):315-27. https://doi.org/10.1213/ANE.0000000000003829
32. Lee CS, Merchant S, Chidambaran V. Postoperative pain management in pediatric spinal fusion surgery for
idiopathic scoliosis. Paediatr Drugs 2020;22(6):575-601. https://doi.org/10.1007/s40272-020-00423-1
33. Chou R, Côté P, Randhawa, Torres P, Yu H, Nordin M, et al. The Global Spine Care Initiative: applying evidencebased guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J 2018;27(6):851-60. https://doi.org/10.1007/s00586-017-5433-8
34. Parrish JM, Jenkins NW, Brundage TS, Hrynewycz NM, Podnar J, Buvanendran A, et al. Outpatient minimally
invasive lumbar fusion using multimodal analgesic management in the ambulatory surgery setting. Int J Spine Surg 2020;14(6):970-81. https://doi.org/10.14444/7146
35. Hong RA, Gibbons KM, Li GY, Holman A, Voepel-Lewis T. A retrospective comparison of intrathecal morphine
and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis. Paediatr Anaesth 2017;27(1):91-7. https://doi.org/ 10.1111/pan.13037
36. Koes BW, van Tulder M, Lin CW, Macedo LC, McAuley J, Maher C. An updated overview of clinical guidelines
for the management of non-specific low back pain in primary care. Eur Spine J 2010;19(12):2075-94. https://doi.org/10.1007/s00586-010-1502-y
37. Man JY, Gurnaney HG, Dubow SR, DiMaggio TJ, Kroeplin GR, Adzick S, et al. A retrospective comparison of
thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum. Paediatr Anaesth 2017;27(12):1227-34. https://doi.org/10.1111/pan.13264
38. Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing
postoperative pain and functional outcomes. J Clin Neurosci 2015;22(6):930-8. https://doi.org/10.1016/j.jocn.2015.01.003
39. Frizzell KH, Cavanaugh PK, Herman MJ. Pediatric perioperative pain management. Orthop Clin North Am
2017;48(4):467-80. https://doi.org/10.1016/j.ocl.2017.06.007
40. Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, et al. Clinical practice guidelines for the
noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury
Management (OPTIMa) Collaboration. Eur J Pain 2017;21(2):201-16. https://doi.org/ 10.1002/ejp.931
41. Young VB. Effective management of pain and anxiety for the pediatric patient in the emergency department. Crit Care Nurs Clin North Am 2017;29(2):205-16. https://doi.org/10.1016/j.cnc.2017.01.007
42. Bull J, Grogan S. Children having spinal surgery to correct scoliosis: A qualitative study of parents’ experiences. J Health Psychol 2010;15(2):299-309. https://doi.org/10.1177/1359105309351607
43. Ntalouka MP, Brotis AG, Bareka MV, Stertsou ES, Fountas KN, Arnaoutoglou EM. Multimodal analgesia in spine surgery: An umbrella review. World Neurosurg 2021;149:129-39. https://doi.org/10.1016/j.wneu.2021.02.040
44. Mathiesen O, Dahl B, Thomsen BA, Kitter B, Sonne N, Dahl JB, et al. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J 2013;22(9):2089-96.
https://doi.org/10.1007/s00586-013-2826-1
45. Momon A, Verdier B, Dolomie JO, Gardette M, Pereira B, Curt I, et al. A Single preoperative administration
of dexamethasone, low-dose pregabalin, or a combination of the 2, in spinal surgery, does not provide a better
analgesia than a multimodal analgesic protocol alone. Clin J Pain 2019;35(7):594-601. https://doi.org/10.1097/AJP.0000000000000719
46. Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in Enhanced
Recovery After Surgery (ERAS) Protocols for postoperative pain. Curr Pain Headache Rep 2020;24(5):21.
https://doi.org/10.1007/s11916-020-00853-z
47. Song K, Melroy MJ, Whipple OC. Optimizing multimodal analgesia with intravenous acetaminophen and opioids in postoperative bariatric patients. Pharmacotherapy 2014;34(Suppl 1):14-21S. https://doi.org/10.1002/phar.1517
48. Chan P, Skaggs DL, Sanders AE, Villamor GA, Choi PD, Tolo VT, et al. Pain is the greatest preoperative concern
for patients and parents before posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976)
2017;42(21):E1245-50. https://doi.org/10.1097/BRS.0000000000002147
49. Landman Z, Oswald T, Sanders J, Diab M. Spinal Deformity Study Group. Prevalence and predictors of pain in
surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2011;36(10):825-9.
https://doi.org/10.1097/BRS.0b013e3181de8c2b
50. Wong GT, Yuen VM, Chow BF, Irwin MG. Persistent pain in patients following scoliosis surgery. Eur Spine J
2007;16(10):1551-6. https://doi.org/10.1007/s00586-007-0361-7
51. Pestieau SR, Finkel JC, Junqueira MM, Cheng Y, Lovejoy JF, Wang J, et al. Prolonged perioperative infusion of
low-dose ketamine does not alter opioid use after pediatric scoliosis surgery. Paediatr Anaesth 2014;24(6):582-90. https://doi.org/10.1111/pan.12417
52. Hwang SW, Pendleton C, Samdani AF, Bastrom TP, Keeny H, Lonner BS, et al. Preoperative SRS pain score
is the primary predictor of postoperative pain after surgery for adolescent idiopathic scoliosis: an observational
retrospective study of pain outcomes from a registry of 1744 patients with a mean follow-up of 3.4 years. Eur Spine J 2020;29, 754–760. https://doi.org/10.1007/s00586-020-06293-y
53. Vademecum Intranet. Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan. Sitio web. 2021. Disponible en: https://farmacia.garrahan.gov.ar/Vademecum/Busqueda
2. Walker CT, Gullotti DM, Prendergast V, Radosevich J, Grimm D, Cole TS, et al. Implementation of standardized
multimodal postoperative analgesia protocol improves pain control, reduces opioid consumption, and shortens
length of hospital stay after posterior lumbar spinal fusion. Neurosurgery 2020;87(1):130-6. https://doi.org/10.1093/neuros/nyz312
3. Cozowicz C, Bekeris J, Poeran J, Zubizarreta N, Schwenk E, Girardi F, et al. Multimodal pain management and
postoperative outcomes in lumbar spine fusion surgery: A population-based cohort study. Spine (Phila Pa 1976)
2020;45(9):580-9. https://doi.org/10.1097/BRS.0000000000003320
4. Piantoni L, Tello CA, Francheri Wilson IA, Remondino R, Galaretto E, et al. Manejo del dolor posoperatorio
por cirugía de columna en la población pediátrica. Resultados preliminares. Rev Asoc Argent Ortop Traumatol
2019;84(3):224-35. https//doi.org/10.15417/issn.1852-7434.2019.84.3.9314
5. Yousefifard M, Askarian-Amiri S, Madani Neishaboori A, Sadeghi M, Saberian P, Baratloo A. Pre-hospital pain
management; a systematic review of proposed guidelines. Arch Acad Emerg Med 2019;7(1):e55. PMID: 31875209
6. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CWC, Chenot JF, et al. Clinical practice guidelines for the
management of non-specific low back pain in primary care: an updated overview. Eur Spine J 2018;27(11):2791-
803. https://doi.org/10.1007/s00586-018-5673-2
7. Hsu JR, Mir H, Wally MK, Seymour RB. Orthopaedic Trauma Association Musculoskeletal Pain Task Force. Clinical practice guidelines for pain management in acute musculoskeletal injury. J Orthop Trauma 2019;33(5):e158-e182. https://doi.org/10.1097/BOT.0000000000001430
8. Aubrun F, Nouette-Gaulain K, Fletcher D, Belbachir A, Beloeil H, Carles M, et al. Revision of expert panel’s
guidelines on postoperative pain management. Anaesth Crit Care Pain Med 2019;38(4):405-11. https://doi.org/10.1016/j.accpm.2019.02.011
9. Shah SA, Guidry R, Kumar A, White T, King A, Heffernan MJ. Current trends in pediatric spine deformity surgery: multimodal pain management and rapid recovery. Global Spine J 2020;10(3):346-52. https://doi.org/10.1177/2192568219858308
10. Sheffer BW, Kelly DM, Rhodes LN, Sawyer JR. Perioperative pain management in pediatric spine surgery. Orthop Clin North Am 2017;48(4):481-6. https://doi.org/10.1016/j.ocl.2017.06.004
11. Johnson MA, Andras LM, Andras LE, Ellington MD, Upasani VV, Shah AS. What’s new in pain management for
pediatric orthopaedic surgery. J Pediatr Orthop 2021;41(10):e923-3928. https://doi.org/10.1097/BPO.0000000000001956
12. Borgeat A, Blumenthal S. Postoperative pain management following scoliosis surgery. Curr Opin Anaesthesiol
2008;21(3):313-6. https://doi.org/10.1097/ACO.0b013e3282f82baa
13. Practice Guidelines for Acute Pain Management in the Perioperative Setting: An Updated Report by the American Society of Anesthesiologists Task Force on Acute Pain Management. Anesthesiology 2012;116:248–273.
https://doi.org/10.1097/ALN.0b013e31823c1030
14. Aoki Y, Iwata H, Akinaga C, Shiko Y, Kawasaki Y, Kobayashi K, et al. Intraoperative remifentanil dosage in surgery for adolescent idiopathic scoliosis does not increase postoperative opioid consumption when combined with epidural analgesia: A retrospective cohort study. Cureus 2021;13(8):e17361. https://doi.org/10.7759/cureus.17361
15. Bean BA, Connor PM, Schiffern SC, Hamid N. Outpatient shoulder arthroplasty at an ambulatory surgery center using a multimodal pain management approach J Am Acad Orthop Surg Glob Res Rev 2018;2:e064.
https://doi.org/10.5435/JAAOSGlobal-D-18-00064
16. Creary SE, Chisolm DJ, Wrona SK, Cooper JN. Opioid prescription filling trends among children with sickle cell
disease after the release of state-issued guidelines on pain management. Pain Med 2020;21(10):2583-92.
https://doi.org/10.1093/pm/pnaa002
17. Joshi GP, Kehlet H. Postoperative pain management in the era of ERAS: An overview. Best Pract Res Clin
Anaesthesiol 2019;33(3):259-67. https://doi.org/10.1016/j.bpa.2019.07.016
18. Joshi GP, Kehlet H; PROSPECT Working Group. Guidelines for perioperative pain management: need for reevaluation. Br J Anaesth 2017;119(4):703-6. https://doi.org/10.1093/bja/aex304
19. Jones JS, Cotugno RE, Singhal NR, Soares N, Semenova J, Nebar S, et al. Evaluation of dexmedetomidine and
postoperative pain management in patients with adolescent idiopathic scoliosis: conclusions based on a retrospective study at a tertiary pediatric hospital. Pediatr Crit Care Med 2014;15(6):e247-52.
https://doi.org/10.1097/PCC.0000000000000119
20. Rawal N. Current issues in postoperative pain management. Eur J Anaesthesiol 2016;33(3):160-71.
https://doi.org/10.1097/EJA.0000000000000366
21. Zieliński J, Morawska-Kochman M, Zatoński T. Pain assessment and management in children in the postoperative period: A review of the most commonly used postoperative pain assessment tools, new diagnostic methods and the latest guidelines for postoperative pain therapy in children. Adv Clin Exp Med 2020;29(3):365-74. https://doi.org/10.17219/acem/112600
22. McNicol ED, Rowe E, Cooper TE. Ketorolac for postoperative pain in children. Cochrane Database Syst Rev
2018;7(7):CD012294. https://doi.org/10.1002/14651858.CD012294.pub2
23. Yoo JS, Ahn J, Buvanendran A, Singh K. Multimodal analgesia in pain management after spine surgery. J Spine
Surg 2019;5(2):S154-9. https://doi.org/10.21037/jss.2019.05.04
24. Rajpal S, Gordon DB, Pellino TA, Strayer AL, Brost D, Trost GR, et al. Comparison of perioperative oral
multimodal analgesia versus IV PCA for spine surgery. J Spinal Disord Tech 2010;23(2):139-45.
https://doi.org/10.1097/BSD.0b013e3181cf07ee
25. Rao KE, Krodel D, Toaz EE, Fanelli J, Hajduk J, Kato K, et al. Introduction of an enhanced recovery pathway
results in decreased length of stay in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion: A description of implementation strategies and retrospective before-and-after study of outcomes. J Clin Anesth 2021;75:110493. https://doi.org/10.1016/j.jclinane.2021.110493
26. YaDeau JT, Dines DM, Liu SS, Gordon MA, Goytizolo EA, Lin Y, et al. What pain levels do TSA patients
experience when given a long-acting nerve block and multimodal analgesia? Clin Orthop Relat Res 2019;477:622-
32. https://doi.org/10.1097/CORR.0000000000000597
27. Pagnotto MR, Pagnano MW. Multimodal pain management with peripheral nerve blocks for total knee arthroplasty. Instr Course Lect 2012;61:389-95. PMID: 22301247
28. Li WT, Bell KL, Yayac M, Barmann JA, Star AM, Austin MS. A postdischarge multimodal pain management
cocktail following total knee arthroplasty reduces opioid consumption in the 30-day postoperative period: A grouprandomized trial. J Arthroplasty 2021;(36) 164e172. https://doi.org/10.1016/j.arth.2020.07.060
29. Karam JA, Schwenk ES, Parvizi J. An update on multimodal pain management after total joint arthroplasty. J Bone Joint Surg Am 2021;103:1652-62. https://doi.org/10.2106/JBJS.19.01423
30. Anderson DE, Duletzke NT, Pedigo EB, Halsey MF. Multimodal pain control in adolescent posterior spinal fusion patients: a double-blind, randomized controlled trial to validate the effect of gabapentin on postoperative pain control, opioid use, and patient satisfaction. Spine Deform 2020;8(2):177-85. https://doi.org/ 10.1007/s43390-020-00038-z
31. Muhly WT, Beltran RJ, Bielsky A, Bryskin RB, Chinn C, Choudhry DK, et al. Perioperative management and
in-hospital outcomes after minimally invasive repair of pectus excavatum: a multicenter registry report from the
society for pediatric anesthesia improvement network. Anesth Analg 2019;128(2):315-27. https://doi.org/10.1213/ANE.0000000000003829
32. Lee CS, Merchant S, Chidambaran V. Postoperative pain management in pediatric spinal fusion surgery for
idiopathic scoliosis. Paediatr Drugs 2020;22(6):575-601. https://doi.org/10.1007/s40272-020-00423-1
33. Chou R, Côté P, Randhawa, Torres P, Yu H, Nordin M, et al. The Global Spine Care Initiative: applying evidencebased guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. Eur Spine J 2018;27(6):851-60. https://doi.org/10.1007/s00586-017-5433-8
34. Parrish JM, Jenkins NW, Brundage TS, Hrynewycz NM, Podnar J, Buvanendran A, et al. Outpatient minimally
invasive lumbar fusion using multimodal analgesic management in the ambulatory surgery setting. Int J Spine Surg 2020;14(6):970-81. https://doi.org/10.14444/7146
35. Hong RA, Gibbons KM, Li GY, Holman A, Voepel-Lewis T. A retrospective comparison of intrathecal morphine
and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis. Paediatr Anaesth 2017;27(1):91-7. https://doi.org/ 10.1111/pan.13037
36. Koes BW, van Tulder M, Lin CW, Macedo LC, McAuley J, Maher C. An updated overview of clinical guidelines
for the management of non-specific low back pain in primary care. Eur Spine J 2010;19(12):2075-94. https://doi.org/10.1007/s00586-010-1502-y
37. Man JY, Gurnaney HG, Dubow SR, DiMaggio TJ, Kroeplin GR, Adzick S, et al. A retrospective comparison of
thoracic epidural infusion and multimodal analgesia protocol for pain management following the minimally invasive repair of pectus excavatum. Paediatr Anaesth 2017;27(12):1227-34. https://doi.org/10.1111/pan.13264
38. Devin CJ, McGirt MJ. Best evidence in multimodal pain management in spine surgery and means of assessing
postoperative pain and functional outcomes. J Clin Neurosci 2015;22(6):930-8. https://doi.org/10.1016/j.jocn.2015.01.003
39. Frizzell KH, Cavanaugh PK, Herman MJ. Pediatric perioperative pain management. Orthop Clin North Am
2017;48(4):467-80. https://doi.org/10.1016/j.ocl.2017.06.007
40. Wong JJ, Côté P, Sutton DA, Randhawa K, Yu H, Varatharajan S, et al. Clinical practice guidelines for the
noninvasive management of low back pain: A systematic review by the Ontario Protocol for Traffic Injury
Management (OPTIMa) Collaboration. Eur J Pain 2017;21(2):201-16. https://doi.org/ 10.1002/ejp.931
41. Young VB. Effective management of pain and anxiety for the pediatric patient in the emergency department. Crit Care Nurs Clin North Am 2017;29(2):205-16. https://doi.org/10.1016/j.cnc.2017.01.007
42. Bull J, Grogan S. Children having spinal surgery to correct scoliosis: A qualitative study of parents’ experiences. J Health Psychol 2010;15(2):299-309. https://doi.org/10.1177/1359105309351607
43. Ntalouka MP, Brotis AG, Bareka MV, Stertsou ES, Fountas KN, Arnaoutoglou EM. Multimodal analgesia in spine surgery: An umbrella review. World Neurosurg 2021;149:129-39. https://doi.org/10.1016/j.wneu.2021.02.040
44. Mathiesen O, Dahl B, Thomsen BA, Kitter B, Sonne N, Dahl JB, et al. A comprehensive multimodal pain treatment reduces opioid consumption after multilevel spine surgery. Eur Spine J 2013;22(9):2089-96.
https://doi.org/10.1007/s00586-013-2826-1
45. Momon A, Verdier B, Dolomie JO, Gardette M, Pereira B, Curt I, et al. A Single preoperative administration
of dexamethasone, low-dose pregabalin, or a combination of the 2, in spinal surgery, does not provide a better
analgesia than a multimodal analgesic protocol alone. Clin J Pain 2019;35(7):594-601. https://doi.org/10.1097/AJP.0000000000000719
46. Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in Enhanced
Recovery After Surgery (ERAS) Protocols for postoperative pain. Curr Pain Headache Rep 2020;24(5):21.
https://doi.org/10.1007/s11916-020-00853-z
47. Song K, Melroy MJ, Whipple OC. Optimizing multimodal analgesia with intravenous acetaminophen and opioids in postoperative bariatric patients. Pharmacotherapy 2014;34(Suppl 1):14-21S. https://doi.org/10.1002/phar.1517
48. Chan P, Skaggs DL, Sanders AE, Villamor GA, Choi PD, Tolo VT, et al. Pain is the greatest preoperative concern
for patients and parents before posterior spinal fusion for adolescent idiopathic scoliosis. Spine (Phila Pa 1976)
2017;42(21):E1245-50. https://doi.org/10.1097/BRS.0000000000002147
49. Landman Z, Oswald T, Sanders J, Diab M. Spinal Deformity Study Group. Prevalence and predictors of pain in
surgical treatment of adolescent idiopathic scoliosis. Spine (Phila Pa 1976) 2011;36(10):825-9.
https://doi.org/10.1097/BRS.0b013e3181de8c2b
50. Wong GT, Yuen VM, Chow BF, Irwin MG. Persistent pain in patients following scoliosis surgery. Eur Spine J
2007;16(10):1551-6. https://doi.org/10.1007/s00586-007-0361-7
51. Pestieau SR, Finkel JC, Junqueira MM, Cheng Y, Lovejoy JF, Wang J, et al. Prolonged perioperative infusion of
low-dose ketamine does not alter opioid use after pediatric scoliosis surgery. Paediatr Anaesth 2014;24(6):582-90. https://doi.org/10.1111/pan.12417
52. Hwang SW, Pendleton C, Samdani AF, Bastrom TP, Keeny H, Lonner BS, et al. Preoperative SRS pain score
is the primary predictor of postoperative pain after surgery for adolescent idiopathic scoliosis: an observational
retrospective study of pain outcomes from a registry of 1744 patients with a mean follow-up of 3.4 years. Eur Spine J 2020;29, 754–760. https://doi.org/10.1007/s00586-020-06293-y
53. Vademecum Intranet. Hospital Nacional de Pediatría Prof. Dr. Juan P. Garrahan. Sitio web. 2021. Disponible en: https://farmacia.garrahan.gov.ar/Vademecum/Busqueda