Multidisciplinary Perioperative Care Pathway in Adolescents Undergoing Posterior Spinal Fusion Surgery
Multidisciplinary Perioperative Care Pathway in Adolescents Undergoing Posterior Spinal Fusion Surgery
Posterior Spinal fusion (PSF) is one of the most invasive orthopedic surgical procedures in
 children and adolescents, often characterized by extensive tissue trauma, and severe
 postoperative pain. In addition to pain, the postoperative period is complicated by the side
 effects of opioids such as nausea and vomiting, itching and sedation. Various studies have
 shown that pain in the direct postoperative phase is an important determinant for development
 of chronic post-surgical pain.

 The consequences of untreated acute pain are known and can also contribute to chronification
 in pain.
Surgical correction of adolescent idiopathic scoliosis (AIS) is indicated for severe
 deformity. Posterior Spinal fusion (PSF) for AIS is one of the most invasive orthopedic
 surgical procedures in children and adolescents, often characterized by a large surgical
 incision, extensive tissue trauma, risk of blood loss, longer operating times and severe
 postoperative pain. In addition to pain, the postoperative period is complicated by the side
 effects of opioids such as nausea and vomiting, itching and sedation. All of this can, along
 with under-treatment of postoperative pain, be an important delaying factor in postoperative
 recovery and rehabilitation with a late hospital discharge and increased patient
 dissatisfaction. Various studies have shown that pain in the direct postoperative phase is an
 important determinant for development of chronic post-surgical pain.

 The consequences of untreated pain are known and can also contribute to chronification in
 pain.

 The incidence of chronic post-surgical pain after scoliosis fusion is 22% at 6 months and
 11-15% at 1 to 5 years postoperatively. It is therefore important to minimize the pain during
 the first postoperative days. Untreated pain in patients is far from benign with significant
 negative short and long term consequences with accompanying reduction in rehabilitation
 duration, sleep quality of life. To date, there is no scientific evidence that some analgesic
 policy is superior, making adequate and safe pain relief and associated anti-emetic therapy
 after PSF a challenge makes for all healthcare providers involved.
Inclusion Criteria:

 -  approved written informed consent by parent or legal representative

 -  idiopathic adolescent scoliosis

 -  planned for elective surgery: posterior spinal fusion

 Exclusion Criteria:

 -  other types of scoliosis

 -  chronic opioid usage (more than 3 months)

 -  known unstable psychiatric medical condition