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

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 understa...

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Autores principales: Shrader, M. Wade, Jones, John, Falk, Mandy N., White, Greg R., Burk, David R., Segal, Lee S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer Berlin Heidelberg 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486500/
https://www.ncbi.nlm.nih.gov/pubmed/25944242
http://dx.doi.org/10.1007/s11832-015-0656-x
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author Shrader, M. Wade
Jones, John
Falk, Mandy N.
White, Greg R.
Burk, David R.
Segal, Lee S.
author_facet Shrader, M. Wade
Jones, John
Falk, Mandy N.
White, Greg R.
Burk, David R.
Segal, Lee S.
author_sort Shrader, M. Wade
collection PubMed
description 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).
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spelling pubmed-44865002015-07-02 Hip reconstruction is more painful than spine fusion in children with cerebral palsy Shrader, M. Wade Jones, John Falk, Mandy N. White, Greg R. Burk, David R. Segal, Lee S. J Child Orthop Original Clinical Article 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). Springer Berlin Heidelberg 2015-05-06 2015-06 /pmc/articles/PMC4486500/ /pubmed/25944242 http://dx.doi.org/10.1007/s11832-015-0656-x Text en © The Author(s) 2015 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
spellingShingle Original Clinical Article
Shrader, M. Wade
Jones, John
Falk, Mandy N.
White, Greg R.
Burk, David R.
Segal, Lee S.
Hip reconstruction is more painful than spine fusion in children with cerebral palsy
title Hip reconstruction is more painful than spine fusion in children with cerebral palsy
title_full Hip reconstruction is more painful than spine fusion in children with cerebral palsy
title_fullStr Hip reconstruction is more painful than spine fusion in children with cerebral palsy
title_full_unstemmed Hip reconstruction is more painful than spine fusion in children with cerebral palsy
title_short Hip reconstruction is more painful than spine fusion in children with cerebral palsy
title_sort hip reconstruction is more painful than spine fusion in children with cerebral palsy
topic Original Clinical Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4486500/
https://www.ncbi.nlm.nih.gov/pubmed/25944242
http://dx.doi.org/10.1007/s11832-015-0656-x
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