Background and aims Adolescent idiopathic scoliosis (AIS) is the most common form of scoliosis, mostly affecting children. Although AIS is a benign disorder with no severe long-term consequences, literature suggests that besides pain, self-image is lower among cohorts with untreated AIS. Posterior spinal fusion (PSF) for AIS correction has a challenging pain management and patients are at risk for persistent postoperative pain. The purpose of this study is the implementation of an enhanced recovery pathway (ERP) including all aspects of integrated biopsychosocial care.
Methods We developed a stepwise approach that started with the critical appraisal of the current perioperative standardized multimodal analgesic protocol for PSF in AIS at our institution. We reviewed the literature considering all aspects of perioperative patient care and evaluated several scores for their potential to quantify biopsychosocial elements that reflect patient wellbeing. Primary outcome parameter was post-operative pain reduction. Secondary outcomes are opioid-related side-effects and mobilization onset. A novel strategy including preemptive gabapentine, a single intraoperative dose of methadone IV (0.2 mg/kg), NSAID and acetaminophen perioperatively in addition to rescue sublingual buprenorphine, was implemented.
Results An ERP was implemented including psychological screening using Web-based questionnaires, early treatment if necessary, extensive patient related outcome measure registration, preemptive multimodal analgesic protocol and long-term follow up using eHealth based telemonitoring devices and online daily questionnaire. Final results are expected 2020.
Conclusions ERP could result in reduced pain and opioid-related side-effects, faster mobilization, earlier hospital discharge and may improve patient satisfaction.
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