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In-hospital opioid usage following posterior spinal fusion for adolescent idiopathic scoliosis: Does methadone offer an advantage when used with an ERAS pathway?

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Abstract

Purpose

Intraoperative methadone has been shown to decrease opioid medication requirement following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). No study to date has investigated the effect of methadone on opioid medication requirement when used in conjunction with an enhanced recovery after surgery (ERAS) protocol following PSF.

Methods

A retrospective cohort study was performed at a single, tertiary care pediatric hospital. Patients with AIS undergoing PSF were consecutively given a single intra-operative methadone dose and matched 1:2 to a AIS control group without methadone. Patients were matched for age, curve magnitude, levels fused, blood loss, and operating time. All children followed a standard ERAS protocol with methadone being the only change in the post-operative regimen. In-hospital data for opioid and non-opioid medication use, surgical, and patient variables were recorded and compared between cohorts.

Results

Twenty-six patients received methadone (average 15.1 ± 1.9 years) and were matched with 52 control patients without methadone (average 14.7 ± 2.2 years). There were no significant differences in total opioid usage at any time-interval prior to hospital discharge or in cumulative opioid usage. Additionally, patients had a similar VAS pain level at discharge (methadone: 4.0 ± 2.3 vs control: 3.8 ± 1.9; P = 0.572). Total opioid usage was correlated with LOS. There were no opioid-related medication complications in either cohort.

Conclusion

There was no decrease of in-hospital opioid usage when methadone was used with an ERAS protocol. Total opioid usage is correlated with hospital LOS following PSF.

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Funding

Implants for this study were provided by OrthoPediatrics.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Dwight D. Eisenhower Army Medical Center, 300 East Hospital Road, Fort Gordon, GA, 30905, USA

    K. Aaron Shaw

  2. Department of Pediatric Orthopaedic Surgery, Children’s Healthcare of Atlanta, Egelston Campus, Atlanta, GA, USA

    Nicholas D. Fletcher

  3. Department of Pediatric Orthopaedic Surgery, Children’s Healthcare of Atlanta, Scottish Rite Campus, Atlanta, GA, USA

    Dennis P. Devito, Michael L. Schmitz, Jorge Fabregas, Simran Gidwani & Joshua S. Murphy

  4. Department of Pediatric Anesthesiology, Children’s Healthcare of Atlanta, Scottish Rite Campus, Atlanta, GA, USA

    Pankaj Chhatbar

Authors
  1. K. Aaron Shaw
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  2. Nicholas D. Fletcher
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  3. Dennis P. Devito
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  4. Michael L. Schmitz
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  5. Jorge Fabregas
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  6. Simran Gidwani
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  7. Pankaj Chhatbar
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  8. Joshua S. Murphy
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Contributions

AS: Data Analysis, Data Interpretation, Manuscript drafting, Manuscript Approval. NDF: Study Design, Data Analysis, Data Interpretation, Manuscript drafting, Manuscript Approval. DPD: Study design, Data Interpretation, Manuscript editing, Manuscript Approval. MLS: Study design, Data Interpretation, Manuscript editing, Manuscript Approval. JF: Study design, Data Interpretation, Manuscript editing, Manuscript Approval. SG: Data Acquisition, Study Design, Manuscript editing, Manuscript Approval. PC: Data Acquisition, Study Design, Manuscript editing, Manuscript Approval. JSM: Study design, Data Interpretation, Manuscript editing, Manuscript Approval.

Corresponding author

Correspondence to K. Aaron Shaw.

Ethics declarations

Conflict of interest

Dr. Shaw is a committee member for NASS; Dr. Fletcher is a paid consultant for Medtronic, is a unpaid consultant for OrthoPediatrics, is a paid speaker for Nuvasive, Zimmer, Medtronic, and OrthoPediatrics, is a committee member for SRS and POSNA, Dr Devito receives royalties from Astura Spine, Medicrea, and SeaSpine, is a paid consultant for Sea Spine, Medicrea, receives research support from K2M, Mazor surgical technologies, received material support from K2M, Medtronic, and is a paid speaker for Medicrea; Dr. Schmitz is a consultant for Stryker, OrthoPediatrics and a board member for Journal of Pediatric Orthopedics, POSNA, and Scoliosis Research Society; Dr. Fabregas is a consultant for Astura Medical, Ms Gidwani has nothing to disclose; Dr. Chhatbar has nothing to disclose; Dr. Murphy is a consultant for Depuy and OrthoPediatrics, receives research support from OrthoPediatrics, and board member for Journal of Pediatric Orthopedics, POSNA, Spine Journal, Journal of Spine Deformity, and Scoliosis Research Society.

Ethical approval

This study was approved by the Institutional Review Board at Children’s Healthcare of Atlanta, Scottish Rite IRB Review.

Informed consent

Not applicable.

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Shaw, K.A., Fletcher, N.D., Devito, D.P. et al. In-hospital opioid usage following posterior spinal fusion for adolescent idiopathic scoliosis: Does methadone offer an advantage when used with an ERAS pathway?. Spine Deform 9, 1021–1027 (2021). https://doi.org/10.1007/s43390-021-00288-5

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  • DOI: https://doi.org/10.1007/s43390-021-00288-5

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