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Updated: Jun 30, 2025
An Experimental Paradigm for the Prediction of Post-Operative Pain PPOP
Published on: January 27, 2010
Postoperative pain and pain management following selective dorsal rhizotomy
Isabel G Adams1, Ramanie Jayaweera2, Jennifer Lewis2
1Australian National University College of Health and Medicine, Canberra, Australian Capital Territory, Australia.
Insights
Selective dorsal rhizotomy (SDR) effectively manages spasticity in cerebral palsy. Postoperative pain is well-controlled with opioid and ketamine infusions, with mild, manageable side effects.
Area of Science:
- Neurosurgery
- Pediatric Orthopedics
- Pain Management
Background:
- Selective dorsal rhizotomy (SDR) is a surgical option for spastic diplegic cerebral palsy to reduce lower limb spasticity.
- Effective pain management is critical for successful rehabilitation after SDR.
- This study evaluates anesthetic and early pain management strategies in pediatric SDR patients.
Purpose of the Study:
- To describe anesthetic and early pain management protocols for SDR.
- To assess pain levels and adverse events in children post-SDR.
- To establish a baseline for improving postoperative care and patient/family education.
Main Methods:
- Retrospective cohort study of 22 children undergoing SDR (2010-2020).
- Review of electronic medical records for demographic, clinical, and medication data.
- Data included pain scores (Wong-Baker FACES), outcomes, adverse events, and anesthetic/postoperative medications.
Main Results:
- Intraoperative medications included remifentanil, ketamine, paracetamol, and sevoflurane.
- Postoperative analgesia involved opioid (morphine, fentanyl, oxycodone) and ketamine infusions.
- Mean pain scores were low (1.4 on POD1, 1.0 on POD6); most side effects (constipation, nausea, vomiting) were mild and managed conservatively.
Conclusions:
- Opioid and ketamine infusions provide effective pain management following SDR.
- Adverse events are common but generally mild and treatable.
- Findings offer a baseline for enhancing postoperative care and informing families about SDR.
Background:
Selective dorsal rhizotomy (SDR) is a neurosurgical procedure that reduces lower limb spasticity, performed in some children with spastic diplegic cerebral palsy. Effective pain management after SDR is essential for early rehabilitation. This study aimed to describe the anaesthetic and early pain management, pain and adverse events in children following SDR.
Methods:
This was a retrospective cohort study. Participants were all children who underwent SDR at a single Australian tertiary hospital between 2010 and 2020. Electronic medical records of all children identified were reviewed. Data collected included demographic and clinical data (pain scores, key clinical outcomes, adverse events and side effects) and medications used during anaesthesia and postoperative recovery.
Results:
22 children (n=8, 36% female) had SDR. The mean (SD) age at surgery was 6 years and 6 months (1 year and 4 months). Common intraoperative medications used were remifentanil (100%), ketamine (95%), paracetamol (91%) and sevoflurane (86%). Postoperatively, all children were prescribed opioid nurse-controlled analgesia (morphine, 36%; fentanyl, 36%; and oxycodone, 18%) and concomitant ketamine infusion. Opioid doses were maximal on the day after surgery. The mean (SD) daily average pain score (Wong-Baker FACES scale) on the day after surgery was 1.4 (0.9), decreasing to 1.0 (0.5) on postoperative day 6 (POD6). Children first attended the physiotherapy gym on median day 7 (POD8, range 7-8). Most children experienced mild side effects or adverse events that were managed conservatively. Common side effects included constipation (n=19), nausea and vomiting (n=18), and pruritus (n=14). No patient required return to theatre, ICU admission or prolonged inpatient stay.
Conclusions:
Most children achieve good pain management following SDR with opioid and ketamine infusions. Adverse events, while common, are typically mild and managed with medication or therapy. This information can be used as a baseline to improve postoperative care and to support families' understanding of SDR before surgery.
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