An Update on Pain Management in Pediatric Spine Surgery

This paper aims to provide an overview on current recommendations for perioperative pain control for pediatric spine surgery. Managing pediatric pain is important to decrease postoperative morbidity, improve early mobilization, and decrease narcotic analgesic use. We aimed to summarize the data on preoperative pain management, intraoperative pain management, and postoperative pain management pathways for pediatric spine surgery.

Pre-operative mental health conditions have been shown to be associated with increased post-operative pain. Intravenous ketorolac and oral gabapentin use postoperatively can improve postoperative pain control and decrease opioid use. While patient-controlled anesthesia is currently widespread after pediatric spine surgery, there is increasing research on regional modalities for pain control, including erector spinae plane blocks, liposomal bupivacaine, epidural analgesia, and intrathecal morphine injections, which are associated with earlier mobilization and decreased narcotic use, with maintained or decreased pain scores. Multimodal pain control, as outlined in Enhanced Recovery After Surgery protocols, is necessary to achieve adequate pain control while decreasing narcotic usage and the associated side effects. Psychosocial factors can impact pain through anxiety and pain catastrophizing. There is increased emphasis on regional and neuraxial anesthesia modalities for pain control. Further research is needed directly comparing the effectiveness of these modalities and further exploring the effect of psychosocial factors on pain and methods to address this.