BACKGROUND Posterior spinal fusion (PSF) surgery for correction of idiopathic scoliosis is associated with chronic postsurgical pain (CPSP). In this multicenter study, we describe perioperative multimodal analgesic (MMA) management and characterize postoperative pain, disability, and quality of life over 12 months after PSF in adolescents and young adults. METHODS Subjects (8-25 years) undergoing PSF were recruited at 6 sites in the United States between 2016 and 2023. Data were collected on pain, opioid consumption (intravenous morphine milligram equivalents (MME)/kg), and use of nonopioid analgesics through postoperative days (POD) 0 and 1. Pain descriptors, functional disability, and quality of life were assessed preoperatively, 2 to 6 and 10 to 12 months after surgery using questionnaires (PainDETECT, Functional Disability Inventory [FDI], and Pediatric Quality of Life Inventory [PedsQL]). Descriptive analyses of analgesic use across and within sites (by preoperative pain and psychological diagnoses), acute postoperative pain and yearly in-hospital analgesic trends are reported. Pain trajectories over 12 months were analyzed using group-based discrete mixture. CPSP (defined as pain score >3/10 beyond 2 months postsurgery), and associated FDI and PedsQL were analyzed. RESULTS In this cohort (343 patients, median [interquartile range {IQR}] 15.2 (13.7-16.6) years, 71.1% female), perioperative use of opioids and nonopioid analgesics significantly varied across sites (P < .001). Preoperatively, gabapentinoids were administered to 48.2% (157/343). Intraoperatively, opioid use included remifentanil (264/337 [78.3%]) and fentanyl (73/337 [21.7%]) infusions, and methadone boluses (159/338 [47%]). Postoperatively, patient-controlled analgesia was commonly used (342/343 [99.9%]). Within sites MMA use did not appear to differ by preoperative pain or psychological comorbidities. Median in-hospital opioid use declined over time (-0.08 [standard error {SE} 0.02] MME/kg/POD 0 to 1 per year, P < .001) while increased use of ketamine (P < .001), methadone (P < .001), dexmedetomidine (P < .001), and regional analgesia (P = .015) was observed. Time spent in moderate-to-severe pain on POD 0 to 1 was ≈33%. CPSP was reported by 24.2% (64/264) with ~17% reporting ongoing neuropathic/likely neuropathic pain. Four postsurgical pain trajectories were identified; 2 (71%) showed resolving pain and 2 (29%) showed persistent mild and moderate-to-severe pain. Although FDI and PedsQL improved over time in both CPSP and non-CPSP groups (P < .001), FDI was higher (P < .001) and PedsQL lower (P = .001) at each time point in the CPSP versus the non-CPSP group. CONCLUSIONS MMA strategies showed site-specific variability and decreasing yearly trends of in-hospital opioid use without changes in acute or chronic pain after PSF. There was a high incidence of persistent pain associated with disability and poor quality of life warrants postoperative surveillance to enable functional recovery.

中文翻译：

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特发性脊柱侧弯脊柱融合术后多模式镇痛实践、疼痛轨迹和恢复趋势的多机构研究。


背景 用于矫正特发性脊柱侧弯的脊柱后路融合术 （PSF） 手术与慢性术后疼痛 （CPSP） 有关。在这项多中心研究中，我们描述了围手术期多模式镇痛 （MMA） 管理，并描述了青少年和年轻人 PSF 后 12 个月内的术后疼痛、残疾和生活质量。方法 2016 年至 2023 年期间，在美国的 6 个地点招募了接受 PSF 的受试者 （8-25 岁）。收集了疼痛、阿片类药物消耗量 （静脉注射吗啡毫克当量 （MME）/kg） 以及术后天数 （POD） 0 和 1 使用非阿片类镇痛药的数据。使用问卷 （PainDETECT、功能障碍量表 [FDI] 和儿科生活质量量表 [PedsQL]）在术前、术后 2 至 6 个月和 10 至 12 个月评估疼痛描述符、功能障碍和生活质量。报告了跨部位和部位内镇痛药使用情况的描述性分析（通过术前疼痛和心理诊断）、术后急性疼痛和每年院内镇痛趋势。使用基于组的离散混合物分析 12 个月的疼痛轨迹。分析 CPSP （定义为术后 2 个月后疼痛评分 >3/10）以及相关的 FDI 和 PedsQL。结果 在这个队列 （343 名患者，中位 [四分位距 {IQR}] 15.2 （13.7-16.6） 岁，71.1% 女性）中，阿片类药物和非阿片类镇痛药的围手术期使用在不同地点显着差异 （P < .001）。术前加巴喷丁类药物给药占 48.2% （157/343）。术中，阿片类药物的使用包括瑞芬太尼 （264/337 [78.3%]） 和芬太尼 （73/337 [21.7%]） 输注，以及美沙酮推注 （159/338 [47%]）。 术后，通常使用患者自控镇痛 （342/343 [99.9%]）。在站点内，MMA 的使用似乎没有因术前疼痛或心理合并症而有所不同。院内阿片类药物使用量的中位数随着时间的推移而下降 （-0.08 [标准误差 {SE} 0.02] MME/kg/POD 每年 0 至 1，P < .001），而氯胺酮 （P < .001）、美沙酮 （P < .001）、右美托咪定 （P < .001） 和局部镇痛 （P = .015） 的使用增加观察到。POD 0 至 1 中度至重度疼痛的时间为 ≈33%。24.2% （64/264） 报告了 CPSP，其中 ~17% 报告了持续的神经性/可能的神经性疼痛。确定了 4 条术后疼痛轨迹;2 例 （71%） 显示疼痛消退，2 例 （29%） 显示持续的轻度和中度至重度疼痛。尽管 CPSP 组和非 CPSP 组的 FDI 和 PedsQL 随着时间的推移而改善 （P < .001），但与非 CPSP 组相比，CPSP 组在每个时间点的 FDI 较高 （P < .001） 和 PedsQL 较低 （P = .001）。结论 MMA 策略显示院内阿片类药物使用的部位特异性变异性和每年下降趋势，而 PSF 后急性或慢性疼痛没有变化。与残疾和生活质量差相关的持续性疼痛的发生率很高，需要术后监测以实现功能恢复。