Hip reconstruction is more painful than spine fusion in children with cerebral palsy

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• 作者：M. Wade Shrader ; John Jones ; Mandy N. Falk…
• 关键词：Cerebral palsy ; Hip reconstruction ; Hip dysplasia ; Scoliosis ; Spine fusion ; Pain control ; Pain assessment
• 刊名：Journal of Children's Orthopaedics
• 出版年：2015
• 出版时间：June 2015
• 年：2015
• 卷：9
• 期：3
• 页码：221-225
• 全文大小：496 KB
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• 作者单位：M. Wade Shrader (1)
  John Jones (1)
  Mandy N. Falk (1)
  Greg R. White (1)
  David R. Burk (1)
  Lee S. Segal (1)
  
  1. Division of Pediatric Orthopaedic Surgery, Phoenix Children’s Hospital, 1919 East Thomas Road, Phoenix, AZ, 85016, USA
  
• 刊物主题：Orthopedics; Pediatrics; Traumatic Surgery;
• 出版者：Springer Berlin Heidelberg
• ISSN：1863-2548

文摘

Purpose Concerns about pain control in patients with cerebral palsy (CP) are especially anxiety provoking for parents, given the fact that spasticity, communication issues, and postoperative muscle spasms are significant problems that make pain control difficult in these patients. A better understanding of the magnitude and quality of the pain these patients experience after our surgical procedures would better prepare the patients and their families. The purpose of this study is to quantify the amount of postoperative pain in children with CP undergoing hip reconstruction and spinal fusion. Specifically, the study will compare pain scores and the amount of narcotics used between the two groups. Materials and methods This is a retrospective chart review of a consecutive series of children with CP (GMFCS levels IV and V) over a 5-year period undergoing hip reconstruction (femoral osteotomy, pelvic osteotomy, or both) and posterior spinal fusion (PSF) at a tertiary-care pediatric hospital. The primary end point was the total opioid used by the patient during the hospitalization, by converting all forms of narcotics to morphine equivalents. The secondary end point was the documentation of pain with standard pain scores at standard time points postoperatively. Adverse effects related to pain management were documented for both groups. Student’s t-tests were utilized to statistically compare differences between the groups, with significance determined at p?<?0.05. Results Forty-two patients with CP who underwent hip reconstruction (mean age 8.8 years) were compared to 26 patients who underwent PSF (mean age 15.4 years). The total opioid used, normalized by body weight and by days length of stay (DLOS), in the hip group was 0.49?mg morphine/kg/DLOS, compared to 0.24 for the spine group (p?=?0.014). The mean pain score for the hip group was 1.52, compared to 0.72 for the spine group (p?=?0.013). There were no significant differences in the occurrence of adverse effects related to pain management between the two groups. Conclusion Patients with CP undergoing hip reconstruction surgery had significantly more pain, as exhibited by requiring more narcotics and having higher pain scores, than those patients undergoing PSF. The knowledge that hip reconstruction is more painful than PSF for patients with CP will better prepare families about what to expect in the postoperative period and will alert providers to supply better postoperative pain control in these patients. Level of evidence III (case control series).