Postoperative Analgesia After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis Current Concept Review

Abstract

This PRISMA-compliant review includes data from 60 studies investigating 14 analgesic treatment modalities. Outcomes discussed included opioid consumption, pain scores, side effects, adverse events, patient satisfaction, resource utilization, and length of stay. Through literature searches of MEDLINE, Embase, The Cochrane Library, and Clinicaltrials.gov 1200 studies were identified.  After removing duplicates, 934 records were screened, and 92 full-text articles were assessed for eligibility. Thirty-two of these were excluded due to lack of sufficient evidence of the efficacy of the analgesic modality or for irrelevant outcome measures. 60 full text articles were included in this review. The aim of this systematic review is to document efficacy, safety and quality of evidence of analgesic interventions after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Potent analgesia with IV opioids or epidural anesthesia remains the cornerstone of postoperative analgesia following PSF for AIS. A diverse set of analgesic adjuvants are under investigation with promising results including GABA-analogues, intrathecal anesthesia, nonsteroidal anti-inflammatory drugs and acetaminophen, ketamine, spinal nerve block, alpha 2 agonists, glucocorticoids, and muscle relaxants. Psychiatric interventions and patient education were also evaluated.