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Article: Efficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial

TitleEfficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial
Authors
Issue Date2016
PublisherGeorg Thieme Verlag. The Journal's web site is located at http://www.thieme.com/gsj
Citation
Global Spine Journal, 2016, v. 06 n. 03, p. 220-228 How to Cite?
AbstractStudy Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed. Autogenous iliac crest bone graft (ICBG) harvesting remains a common procedure worldwide for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern in patients undergoing spine surgery that affects postoperative functional outcome and consumes health care resources. Previous studies have noted a decrease in pain and postoperative analgesic use with the application of continuous infusion of anesthetic at the ICBG site in comparison with placebo. However, there is lack of evidence addressing the efficacy of continuous anesthetic infusion at the ICBG site in young patients and in particular those with spinal deformity, such as AIS. As such, this parallel, double-blinded, randomized controlled trial addressed the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in patients with AIS during the immediate postoperative period. Methods Participants were randomized into two groups. Group A (control subjects) received 3 mL per hour of saline locally at the ICBG site, and group B (treatment subjects) received a constant rate of infusion of 3 mL per hour of 0.25% levobupivacaine. Both groups received their postoperative intervention for 47 hours. All subjects and outcome assessors were blinded to the type of intervention. Utilizing the visual analog pain scale, pain was assessed at the primary spine surgical site, ICBG site, and contralateral ICBG site. Overall physical pain was assessed by the McGill Pain Questionnaire. The degree of analgesic use and complications were also evaluated. All outcomes were assessed up until the fourth day of the patients' hospitalization following surgery. Results Twelve subjects were recruited (five in group A; seven in group B). No difference was noted at baseline regarding age, weight, height, arm span, sex, curve type, instrumented and fused levels, length of hospitalization, and pain scores between groups. Postoperatively, no difference was noted in surgical site pain between groups (p > 0.05). However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A. Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8). No significant differences were noted for the pain scores due to the small sample size. Conclusions This study is the first with a robust level I study design to assess the efficacy of continuous infusion of analgesia into the ICBG site in young patients with AIS. This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters. This study provides further support of postoperative pain management options for children with spinal deformities.
Persistent Identifierhttp://hdl.handle.net/10722/216714
ISSN
2015 SCImago Journal Rankings: 0.108

 

DC FieldValueLanguage
dc.contributor.authorSamartzis, D-
dc.contributor.authorBow, HYC-
dc.contributor.authorCheung, JPY-
dc.contributor.authorSham, PLM-
dc.contributor.authorMak, KC-
dc.contributor.authorCheung, WY-
dc.contributor.authorWong, YW-
dc.contributor.authorLuk, KDK-
dc.contributor.authorCheung, KMC-
dc.contributor.authorLaw Min, J-
dc.date.accessioned2015-09-18T05:36:27Z-
dc.date.available2015-09-18T05:36:27Z-
dc.date.issued2016-
dc.identifier.citationGlobal Spine Journal, 2016, v. 06 n. 03, p. 220-228-
dc.identifier.issn2192-5682-
dc.identifier.urihttp://hdl.handle.net/10722/216714-
dc.description.abstractStudy Design Randomized controlled trial. Objective Adolescent idiopathic scoliosis (AIS) is a common spinal deformity that affects every population. In severe deformity, surgical intervention is performed. Autogenous iliac crest bone graft (ICBG) harvesting remains a common procedure worldwide for scoliosis surgery. Postoperative pain at the ICBG donor site is a major concern in patients undergoing spine surgery that affects postoperative functional outcome and consumes health care resources. Previous studies have noted a decrease in pain and postoperative analgesic use with the application of continuous infusion of anesthetic at the ICBG site in comparison with placebo. However, there is lack of evidence addressing the efficacy of continuous anesthetic infusion at the ICBG site in young patients and in particular those with spinal deformity, such as AIS. As such, this parallel, double-blinded, randomized controlled trial addressed the pain management efficacy of continuous anesthetic infusion versus saline at the ICBG site in patients with AIS during the immediate postoperative period. Methods Participants were randomized into two groups. Group A (control subjects) received 3 mL per hour of saline locally at the ICBG site, and group B (treatment subjects) received a constant rate of infusion of 3 mL per hour of 0.25% levobupivacaine. Both groups received their postoperative intervention for 47 hours. All subjects and outcome assessors were blinded to the type of intervention. Utilizing the visual analog pain scale, pain was assessed at the primary spine surgical site, ICBG site, and contralateral ICBG site. Overall physical pain was assessed by the McGill Pain Questionnaire. The degree of analgesic use and complications were also evaluated. All outcomes were assessed up until the fourth day of the patients' hospitalization following surgery. Results Twelve subjects were recruited (five in group A; seven in group B). No difference was noted at baseline regarding age, weight, height, arm span, sex, curve type, instrumented and fused levels, length of hospitalization, and pain scores between groups. Postoperatively, no difference was noted in surgical site pain between groups (p > 0.05). However, decreased ICBG and contralateral ICBG pain decreased twofold in group B patients in comparison with group A. Similarly, group B subjects had notably decreased postoperative overall pain scores (group A, mean 15.3; group B, mean 3.8). No significant differences were noted for the pain scores due to the small sample size. Conclusions This study is the first with a robust level I study design to assess the efficacy of continuous infusion of analgesia into the ICBG site in young patients with AIS. This pilot study noted a trend that continuous anesthetic infusion reduces pain at the ICBG site and may further decrease overall physical bodily pain. This study further established a sample size calculation to facilitate large-scale studies addressing these parameters. This study provides further support of postoperative pain management options for children with spinal deformities.-
dc.languageeng-
dc.publisherGeorg Thieme Verlag. The Journal's web site is located at http://www.thieme.com/gsj-
dc.relation.ispartofGlobal Spine Journal-
dc.rightsGlobal Spine Journal. Copyright © Georg Thieme Verlag.-
dc.rightsCreative Commons: Attribution 3.0 Hong Kong License-
dc.titleEfficacy of Postoperative Pain Management Using Continuous Local Anesthetic Infusion at the Iliac Crest Bone Graft Site in Patients with Adolescent Idiopathic Scoliosis: A Parallel, Double-Blinded, Randomized Controlled Pilot Trial-
dc.typeArticle-
dc.identifier.emailSamartzis, D: dspine@hku.hk-
dc.identifier.emailBow, HYC: cbow@hku.hk-
dc.identifier.emailCheung, JPY: cheungjp@hku.hk-
dc.identifier.emailMak, KC: kincmak@hku.hk-
dc.identifier.emailCheung, WY: lcheung@hkucc.hku.hk-
dc.identifier.emailWong, YW: yatwa@hkucc.hku.hk-
dc.identifier.emailLuk, KDK: hrmoldk@hkucc.hku.hk-
dc.identifier.emailCheung, KMC: cheungmc@hku.hk-
dc.identifier.authoritySamartzis, D=rp01430-
dc.identifier.authorityCheung, JPY=rp01685-
dc.identifier.authorityMak, KC=rp01957-
dc.identifier.authorityLuk, KDK=rp00333-
dc.identifier.authorityCheung, KMC=rp00387-
dc.description.naturepublished_or_final_version-
dc.identifier.doi10.1055/s-0035-1558656-
dc.identifier.hkuros252278-
dc.identifier.volume06-
dc.identifier.issue03-
dc.identifier.spage220-
dc.identifier.epage228-
dc.publisher.placeGermany-

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