Facebook Twitter YouTube

HIP Reconstruction Is MORE Painful THAN SPINE Fusion In Patients with Cerebral Palsy

Sunday, October 21, 2012: 9:17 AM
Melrose (Hilton Riverside)
M. Wade Shrader, MD1, John Jones, MD2, Mandy Nowlin, PA-C3, David R. Burk, BS2 and Lee S. Segal, MD1, (1)Orthopaedics, Phoenix Children's Hospital, Phoenix, AZ, (2)Phoenix Childrens Hospital, Phoenix, AZ, (3)Orthopaedics, Phoenix Childrens Hospital, Phoenix, AZ

Purpose: Concerns about pain control in patients with Cerebral Palsy (CP) are especially anxiety provoking for parents, given the fact that spasticity, communication issues, and postoperative muscle spasms are significant issues that make pain control difficult in these patients.   A better understanding of the magnitude and the quality of the pain these patients experience after our surgical procedures would better prepare the patients and families.  The purpose of this study is to quantify the amount of postoperative pain in children with CP undergoing hip reconstruction and spinal fusion.  Specifically, the study will compare pain scores and the amount of narcotic used between the two groups.

Methods: This is a retrospective chart review of all children with CP over a ten year period undergoing hip reconstruction (femoral osteotomy, pelvic ostoetomy, or both) and posterior spinal fusion at a tertiary-care pediatric hospital.   The primary end point was the total narcotic used by the patient during the hospitalization, by converting all forms of narcotics to morphine equivalents.  The secondary end point was the documentation of pain with standard pain scores at standard time points postoperatively.  Adverse effects related to pain management were documented for both groups.  Student’s t-tests were utilized to statistically compare differences between the groups, with significance determined at p<0.05.

Results: 42 patients with CP who underwent hip reconstruction (mean age 8.3) were compared to 26 patients (mean age 15) who underwent PSF.   The total narcotic used, normalized by body weight and by days length of stay (DLOS), in the hip group was 0.49 mg Morphine/kg/DLOS, compared to 0.24 for the spine group (p=0.014).    The mean pain score (visual analog scale, or VAS score) for the hip group was 1.52 compared to 0.72 for the spine group (p=0.013). There were no significant differences in the occurrence of adverse effects related to pain management between the two groups. 

Conclusion: Patients with CP undergoing hip reconstruction surgery had significantly more pain, as exhibited by requiring more narcotic and having higher pain scores, than those patients undergoing PSF.  Hip reconstruction is more painful than PSF in patients with CP.  This knowledge will better prepare families about what to expect in the postoperative period, and will alert providers to allow us to provide better postoperative pain control in these patients.