Blog Topic: Pain Control and Muscle Spasm Management after Idiopathic Scoliosis Surgery

 

11-12-2021

 

1.      Preoperatively

At  At the last outpatient clinic visit before surgery, all patients will also have a visit with the Pediatric Anesthesia service on the same day.  This group of physicians and Advanced Practice Providers (AAPs) will provide the general anesthesia (means the patient will be asleep) for the entire surgical procedure AND manage the postoperative pain and muscle spasms (by the Pain Service). 

2.      After surgery, the Pain Service will start its care immediately after surgery and will continue care until hospital discharge.

       Postoperatively

3.      Pain management. after surgery will be a combination of opioids and non-opioid medications.  By using non-opioid medications the amount of opioid medications can be minimized. The negative aspects of opioids are well-known, specifically addiction. In the short-term, after surgery, these medications also decrease breathing rate, lower blood pressure, induce nausea and vomiting and create constipation.  These are all great reasons to minimize opioids, as much as possible.  The below medications in our protocol work together to minimize pain and the side effects of opioids.

a.      Opioids:

                                                    i.     Intravenous morphine or morphine-equivalent medication, by a device call a PCA which stands for “Patient-Controlled Analgesia”: day 0-1

                                                   ii.     Oral oxycodone: days 1 to discharge

b.      Use of non-opioids

                                                    i.     Intravenous ketorolac: days 0-2

                                                   ii.     Oral acetaminophen: days 0 to discharge

4.      Muscle spasm management. Spine surgery requires operating around or through muscle, which creates swelling and secondarily muscle spasm.  To minimize muscle spasm the below medication are used, and they work together with the above-mentioned pain medications to make the patients as comfortable as possible.

a.      Methocarbamol: days 0-2

b.      Diazepam: days 0-2

c.      Flexeril: days 2+

5.      Discharge (at-home treatment).  The below medications are the typical medications spine patients have for pain and muscle spasm management.

a.      Oral oxycodone (as needed)

b.      Flexeril (as needed)

c.      Acetaminophen (as needed)

6.      Pain Service is available to patient/family as needed to optimize patient comfort.

7.      Gradually pain and muscle spasm will resolve, with most patients using only oral acetaminophen about 2 weeks after surgery.