PDF(Pubmed)
Abstract：
Postoperative care pathways for adolescent idiopathic scoliosis patients undergoing posterior spinal fusion have demonstrated decreases in postoperative opioid consumption, improved pain control, and lead to decreased lengths of stay. Our objective was to implement postoperative steroids to reduce acute postoperative opioid consumption, pain scores, and length of stay. Dosing consisted of intravenous dexamethasone 0.1 mg/kg up to 4 mg per dose for a total of three doses at 8, 16, and 24 h postoperatively. As part of a quality initiative, we compared three cohorts of patients. The initial retrospective epidural cohort (EPI) (n = 59) had surgeon placed epidural catheters with infusion of ropivacaine 0.1% postoperatively for 18-24 h. Following an institutional change in postoperative care, epidural use was discontinued. A second cohort (n = 149), with prospectively collected data, received a surgeon placed erector spinae plane block and wound infiltration with a combination of liposomal and plain bupivacaine (LB). A third cohort (n = 168) was evaluated prospectively. This cohort received a surgeon placed erector spinae plane block and wound infiltration with liposomal and plain bupivacaine and additionally received postoperative dexamethasone for three doses (LB + D). Compared to the LB cohort, the LB + D cohort demonstrated statistically significant decreases in oral milligram morphine equivalents per kilogram at 0-24, 24-48, and 48-72 h. There was a statistically significant difference in median pain scores at 24-48 and 48-72 h in LB + D versus LB. The LB + D cohort\'s median length of stay in hours was significantly less compared to the LB cohort (52 h vs. 70 h, p < 0.0001). Postoperative intravenous dexamethasone was added to an established postoperative care pathway for patients undergoing posterior spinal fusion for idiopathic scoliosis resulting in decreased VAS pain scores, opioid consumption, and shorter length of stay.
摘要：
接受后路脊柱融合术的青少年特发性脊柱侧凸患者的术后护理途径表明，术后阿片类药物的消耗减少，改善疼痛控制，并导致停留时间减少。我们的目标是实施术后类固醇以减少术后急性阿片类药物的消耗，疼痛评分,和逗留时间的长短。给药包括静脉内地塞米松0.1mg/kg至每剂量4mg，共三个剂量，术后8、16和24小时。作为质量计划的一部分，我们比较了三组患者.最初的回顾性硬膜外队列（EPI）（n=59）让外科医生在术后18-24小时内放置硬膜外导管并输注0.1％的罗哌卡因。硬膜外使用已停止.第二个队列（n=149），有了前瞻性收集的数据，接受了外科医生放置直立脊髓平面阻滞和伤口浸润的脂质体和普通布比卡因（LB）的组合。第三个队列（n=168）进行了前瞻性评估。该队列接受了外科医生放置的竖脊肌平面阻滞和脂质体和普通布比卡因的伤口浸润，并另外接受了三个剂量的术后地塞米松（LBD）。与LB队列相比，LB+D队列在0-24,24-48和48-72h时显示出每公斤口服吗啡毫克当量的统计学显著下降。LB+D与LB在24-48和48-72h时的中位疼痛评分有统计学差异。与LB队列相比，LB+D队列的中位住院时间（以小时为单位）明显较少（52h与70小时,p<0.0001)。对于特发性脊柱侧凸后路脊柱融合术患者，术后静脉注射地塞米松被添加到既定的术后护理路径中，导致VAS疼痛评分降低，阿片类药物的消费，更短的停留时间。
