A retrospective study of the effects of a pain management protocol for pediatric posterior spinal fusion

Patient controlled analgesia (PCA) is widely used to treat post-operative pain for pediatric patients with Posterior Spinal Fusion (PSF); however, studies show that patients continue to have moderate to severe pain over the immediate post operative period. Studies are published supporting and contraindicating the use of ketorolac in children undergoing scoliosis surgery. This retrospective quantitative study will explore the patient outcomes such as pain scores, length of stay, side effects related to the use of opioids and ketorolac post operatively after PSF using a pain management protocol. Charts of all patients with diagnosis of PSF from two orthopedic surgeons in a 24 month period before and after a post operative pain management protocol in a pediatric hospital in the Midwestern United States were be reviewed. Data analysis was performed using Proc GLM in SAS 9.1, Fisher's exact test in Proc Frequency, and Kruskal-Wallis Test in Proc NPAR1WAY in SAS 9.1.correlating specific data values of: pain scores, length of stay, PCA days, IV opioids given after PCA discontinued, presence of ileus, post operative bleeding and use of IV ketorolac. The findings showed there was a difference in maximal pain scores between groups on POD1 p-value= 0.0587 and POD2 p-value= 0.0702; Number of days on PCA p-value =0.0127 and LOS p-value = 0.0485; IVP medications on POD2 p-value 0.0367 and POD4 p-value 0.0205. However, there was no significant difference found in N/V on POD2 &3 and no ileus or increase bleeding was noted between groups. Pediatric patients who have PSF experience moderate to severe pain in the immediate post-operative period. The use of IV ketorolac and early implementation of oral opioids did improve maximal pain scores without increasing vomiting. There may also be a decrease in PCA days and LOS for pediatric patients with PSF.