Intraoperative opioid infusion versus balanced opioid-sparing approach on the incidence of chronic postsurgical pain and inpatient opioid consumption in children undergoing posterior spinal fusion surgery for adolescent idiopathic scoliosis: a 12-year retrospective observational cohort study

Abstract

Objective: There has been a trend toward opioid-sparing anesthesia in recent years, for which the long-term impact on the incidence of chronic postsurgical pain (CPSP) has not been elucidated. Therefore, the primary objective of this study was to determine if a change in opioid-sparing intraoperative management influenced the rate of CPSP in children who underwent posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).

Methods: This retrospective cohort was derived from the electronic medical records at Texas Children's Hospital from patients who underwent PSF for AIS from January 1, 2012, through July 2, 2024. The primary outcome was the incidence of CPSP at the 12-week follow-up visit and requiring regular use of nonopioid analgesics. Secondary outcomes included hospital length of stay (LOS) and postoperative opioid consumption expressed as oral morphine equivalents (OME) per kilogram. The exposure was the use of an opioid as a continuous infusion during the intraoperative period.

Results: The authors identified 774 patients who met inclusion criteria, of whom 162 (20.9%) reported CPSP with continued analgesic use at 12 weeks postoperatively. The incidence of CPSP was not associated with the use of opioids as a continuous infusion intraoperatively when compared with nonopioid infusion management (OR 1.32, 95% CI 0.87-1.99; p = 0.19). Opioid infusion was associated with a reduced LOS (mean 4.4 vs 4.1 days, p < 0.001; Cohen's d = -0.28; 95% CI -0.43 to -0.13) and increased total postoperative opioid consumption (mean 4.9 vs 3.9 mg/kg OME p < 0.001; Cohen's d = 0.35, 95% CI 0.20-0.50) when compared with nonopioid infusion management. Preoperative back pain and female sex were independently associated with CPSP (OR 2.03, 95% CI 1.39-2.96, p < 0.001 and OR 1.93, 95% CI 1.17-3.19; p = 0.01, respectively).

Conclusions: The findings of this study suggest that intraoperative opioid administration by continuous infusion after PSF for AIS was not associated with an increased risk of CPSP. Continuous opioid infusion was associated with significantly increased postoperative opioid use. Preoperative back pain and female sex were independently associated with CPSP at 12 weeks.

Keywords: analgesia; chronic pain; opioid sparing; pediatrics; scoliosis; spinal fusion; spine; surgery.