Implementing an Interdisciplinary Enhanced Recovery Pathway for adolescents with Idiopathic Scoliosis undergoing Posterior Spinal Fusion using patient portal based Telemonitoring for short and long-term follow up
Lana Van Hoorick, Margaretha Breebaart, Vera Saldien, Jozef Michielsen, Guy Hans and Davina Wildemeersch
University Hospital Antwerp, Belgium
: J Spine Neurosurg
Statement of the Problem: The large surgical incision and severe tissue trauma in Posterior Spinal Fusion (PSF) for Adolescent Idiopathic Scoliosis (AIS) cause severe acute postoperative pain. Furthermore, PSF is associated with a risk of Persistent Postsurgical Pain (PPSP). Six months after PSF, the incidence of PPSP is as high as 22% of the patients. Optimizing pain management, therefore, remains crucial but challenging. The purpose of this study is to design and implement an Enhanced Recovery Pathway (ERP) with all aspects of biopsychosocial care integrated for adolescents with AIS undergoing PSF. Additionally, postoperative pain and PPSP are evaluated up to 12 weeks post PSF. Methodology & Theoretical Orientation: In December 2019, a prospective cohort study was set up in which an ERP substitutes more than the Patient-Controlled Intravenous Analgesia (PCIA) containing morphine postoperatively. This ERP consists of m/eHealth based psychological screening questionnaires, patient education, early mobilization, and a multimodal analgesia protocol consisting of preemptive gabapentin, an intraoperatively given single dose of methadone (0.2 mg/kg), non-steroidal anti-inflammatory drugs, and acetaminophen. Sublingual buprenorphine is used as a rescue analgetic. Findings: A total of 23 ERP vs standard of care patients, with an average age of 14.5 years [11- 18], were included in the control group. An average of 10 vertebrae [6- 13] was fused. Most of the patients were nauseous during their hospital stay (n=16, 70%). Numeric rating scale pain scores from postoperative days 1 to 5 are 3.65, 3.51, 3.57, 3.03, and 2.82, respectively. Patients stayed in the hospital for an average of 7.48 days [5-12]. ERP results are expected in 2021. Conclusion & Significance: Using an ERP for patients undergoing PSF could not only reduce the acute and chronic opioid consumption and its side effects but could also result in less postoperative pain, shorter hospital stay, and higher patient satisfaction.
Lana Van Hoorick is a Resident in Anaesthesiology at the Antwerp University Hospital. She received her master’s in medicine at the University of Antwerp. Her current research interests include Pain Management and Multimodal Analgesia.