419: Title: Postoperative Pain Management after Posterior Spinal Fusion Surgery in Children

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Acute postsurgical pain, Pharmacological treatments, Pain in special populations (e.g. neonates, children, teens, elderly, neurodegenerative diseases)

Background and Aims: Surgical correction of scoliosis in children is crucial for preventing disease progression and lung function deterioration.

However, factors such as bone trauma, impaired circulation, and soft tissue edema contribute to significant postoperative pain, potential complications, including chronic pain syndromes.

This study aimed to compare three approaches to postoperative pain management in a pediatric population.

Methods: We conducted a randomized controlled trial involving 60 children aged 10 to 17 years undergoing posterior spinal fusion surgery.

Participants were assigned to one of three groups: Group 1 (n=20) received transdermal fentanyl combined with continuous epidural analgesia using a local anesthetic; Group 2 (n=20) received only epidural analgesia; Group 3 (n=20) - intravenous (IV) narcotic analgesics.


Pain severity using the Visual Analog Scale (VAS), noninvasive hemodynamic parameters (blood pressure and heart rate), patient activity levels, POTR were evaluated every four hours during the first 72 hours postoperatively to assess effectiveness.

Results: Results: Group 1 achieved superior pain relief, with an average VAS score of 1.8 ± 0.07, significantly lower than Group 2 (3.06 ± 2.0) and Group 3 (5.06 ± 2.0; U=1531.50, p<0.005). Intergroup comparisons of noninvasive hemodynamic parameters revealed no significant differences. The incidence of nausea and vomiting was 7% in Group 1, 13% in Group 2, and 33% in Group 3. Patients in Group 1 were able to sit and cough painlessly from the first postoperative day, unlike those in Groups 2 and 3 who demonstrated higher pain levels (ANOVA=201.2, p<0.005).

Conclusions: Conclusions: The combination of epidural local anesthetic administration and transdermal fentanyl delivery is the most effective postoperative analgesia approach for children undergoing spinal fusion surgery, improving pain management and patient mobility while reducing complications.

References: 1) Theodore H. Stanley «The Fentanyl Story» // The Journal of Pain, 2014.
2) Jan Hudec , Tereza Prokopová, Martina Kosinová and Roman Gál «Anesthesia and Perioperative Management for Surgical Correction of Neuromuscular Scoliosis in Children: A Narrative Review»J. Clin. Med. 2023.

Presenting Author: Olga Pulkina
Submitting Author: olga pulkina

Senior Author: Olga Pulkina

IASP 2026 Global Year theme of Neuropathic Pain: No

• Diana Gogihaeva: not - SPb NIIF