Eli S Ahdoot1, Juston Fan, Afshin Aminian. 1. From the Orthopaedic Surgery, Riverside University Health System Medical Center, Moreno Valley, CA (Dr. Ahdoot, Dr. Fan), and the Orthopedic Institute, CHOC Children's, Orange, CA (Dr. Aminian).
Abstract
INTRODUCTION: Postoperative pain protocols play a critical role in recovery and prognosis. Rapid recovery pathway (RRP) is a novel multimodal postoperative analgesic platform with accelerated rehabilitation. METHODS: A retrospective review of 44 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion between 2014 and 2016 was conducted. Outcomes of a conventional postoperative pain pathway were compared with patients who received RRP postoperatively. RESULTS: RRP patients had shorter length of stay (3.3 vs 4.4 days, P < 0.0001), duration with Foley (1.4 vs 2.3 days, P = 0.01), and fewer days for physical therapy clearance (2.2 vs 3.5 days, P < 0.0001). Overall pain score for RRP patients was lower (1.6 vs 2.9, P = 0.0005). The number of days with patient-controlled analgesia was shorter (1.7 vs 2.6 days, P = 0.002), and daily pain scores were consistently lower in RRP. Overall narcotic use was not significantly different (P = 1). CONCLUSION: Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced daily and overall pain scores, earlier clearance by physical therapy, decreased length of stay, and patient-controlled analgesia usage, but overall no difference in narcotic consumption. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.
INTRODUCTION: Postoperative pain protocols play a critical role in recovery and prognosis. Rapid recovery pathway (RRP) is a novel multimodal postoperative analgesic platform with accelerated rehabilitation. METHODS: A retrospective review of 44 patients with adolescent idiopathic scoliosis who underwent posterior spinal fusion between 2014 and 2016 was conducted. Outcomes of a conventional postoperative pain pathway were compared with patients who received RRP postoperatively. RESULTS: RRP patients had shorter length of stay (3.3 vs 4.4 days, P < 0.0001), duration with Foley (1.4 vs 2.3 days, P = 0.01), and fewer days for physical therapy clearance (2.2 vs 3.5 days, P < 0.0001). Overall pain score for RRP patients was lower (1.6 vs 2.9, P = 0.0005). The number of days with patient-controlled analgesia was shorter (1.7 vs 2.6 days, P = 0.002), and daily pain scores were consistently lower in RRP. Overall narcotic use was not significantly different (P = 1). CONCLUSION: Implementation of a standardized RRP with multimodal pain management and early mobilization strategies resulted in reduced daily and overall pain scores, earlier clearance by physical therapy, decreased length of stay, and patient-controlled analgesia usage, but overall no difference in narcotic consumption. LEVEL OF EVIDENCE: Level III, Retrospective Cohort Study.
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