Presenter Status
Medical Student
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Aaron Shaw
Presentation Type
Poster
Start Date
21-5-2026 11:00 AM
End Date
21-5-2026 12:00 PM
Abstract Text
Background:
Opioid stewardship is a vital component to postsurgical care, which is particularly true in medically complex patients, such as those with nonambulatory cerebral palsy (CP), who are sensitive to the side effects of these medications. However, few studies to date have investigated means to minimize opioid utilization following major orthopedic interventions in this at-risk population.
Objectives/Goal:
The present study aims to answer the question of whether or not intraoperative liposomal bupivacaine reduces the use of postoperative opioids in pediatric patients with CP after posterior spinal fusion (PSF). It also aims to measure the difference in length of stay between the two treatment pathways.
Methods/Design:
A single-center, retrospective study of children with neuromuscular scoliosis associated with nonambulatory CP undergoing primary PSF over a 3-year period was performed. Patients were subdivided according to their peri-operative pain pathway into two cohorts: Traditional pathway (TP) including intraoperative methadone and a postoperative hydromorphone PCA with continuous infusion managed by the anesthesia pain team, or the accelerated pathway (AD) including intraoperative liposomal bupivacaine (LB) with postoperative dexamethasone (when medically appropriate) and preferential avoidance of postoperative PCA. Inpatient opioid usage was recorded using morphine equivalents (MME). Between group analyses were performed assessing opioid consumption, mean daily pain (measured by VAS), and length of hospital stay (LOS).
Results:
A total of 26 patients met inclusion (mean: 12.9±2.87 years, 53.8% female). Seven patients were managed by the TP whereas 19 were managed with AD. AD patients demonstrated a shorter length of hospital stay (AD: 3.9±1.4 days vs TP:9.1±7.8 days, P< 0.001) and lower total opioid usage (AD:37.5±46.0 MME vs TP:351.9±301.1; P=0.002, Figure 1) which was further reduced in those patients who received dexamethasone therapy (AD+Dex[N=15]:25.1±30.5 vs AD-Dex[N=4]:83.8±68.9, P=0.04). The AD patients also demonstrated decreased total inpatient opioid use standardized to weight (AD:1.2±1.4 MME/kg vs TP:8.2±6.2 MME/kg; P=0.002)
Conclusions:
The utilization of an accelerated discharge pathway, incorporating intraoperative LP infiltration and postsurgical dexamethasone therapy resulted in a significant decrease in length of hospital stay and postsurgical opioid utilization in children with non-ambulatory CP undergoing PSF.
Improving Care in Neuromuscular Scoliosis: Accelerated Discharge Pathways Decreases Length of Stay and Opioid Utilization Following Primary Posterior Spinal Fusion
Background:
Opioid stewardship is a vital component to postsurgical care, which is particularly true in medically complex patients, such as those with nonambulatory cerebral palsy (CP), who are sensitive to the side effects of these medications. However, few studies to date have investigated means to minimize opioid utilization following major orthopedic interventions in this at-risk population.
Objectives/Goal:
The present study aims to answer the question of whether or not intraoperative liposomal bupivacaine reduces the use of postoperative opioids in pediatric patients with CP after posterior spinal fusion (PSF). It also aims to measure the difference in length of stay between the two treatment pathways.
Methods/Design:
A single-center, retrospective study of children with neuromuscular scoliosis associated with nonambulatory CP undergoing primary PSF over a 3-year period was performed. Patients were subdivided according to their peri-operative pain pathway into two cohorts: Traditional pathway (TP) including intraoperative methadone and a postoperative hydromorphone PCA with continuous infusion managed by the anesthesia pain team, or the accelerated pathway (AD) including intraoperative liposomal bupivacaine (LB) with postoperative dexamethasone (when medically appropriate) and preferential avoidance of postoperative PCA. Inpatient opioid usage was recorded using morphine equivalents (MME). Between group analyses were performed assessing opioid consumption, mean daily pain (measured by VAS), and length of hospital stay (LOS).
Results:
A total of 26 patients met inclusion (mean: 12.9±2.87 years, 53.8% female). Seven patients were managed by the TP whereas 19 were managed with AD. AD patients demonstrated a shorter length of hospital stay (AD: 3.9±1.4 days vs TP:9.1±7.8 days, P< 0.001) and lower total opioid usage (AD:37.5±46.0 MME vs TP:351.9±301.1; P=0.002, Figure 1) which was further reduced in those patients who received dexamethasone therapy (AD+Dex[N=15]:25.1±30.5 vs AD-Dex[N=4]:83.8±68.9, P=0.04). The AD patients also demonstrated decreased total inpatient opioid use standardized to weight (AD:1.2±1.4 MME/kg vs TP:8.2±6.2 MME/kg; P=0.002)
Conclusions:
The utilization of an accelerated discharge pathway, incorporating intraoperative LP infiltration and postsurgical dexamethasone therapy resulted in a significant decrease in length of hospital stay and postsurgical opioid utilization in children with non-ambulatory CP undergoing PSF.
Comments
Poster Board Number: 25