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.