Trajectory of Post-operative Wound Pain within the First Two Weeks following Posterior Spinal Fusion Surgery in Adolescent Idiopathic Scoliosis Patients.

STUDY DESIGN: Prospective Cohort Study.

OBJECTIVE: To determine and evaluate the trajectory of surgical wound pain from day 1 to day 14 after PSF surgery in AIS patients.

SUMMARY OF BACKGROUND DATA: Information regarding how the post-operative pain improves with time offers invaluable information not only to the patients and parents but also to assist the clinician in managing post-operative pain.

METHODS: AIS patients who were planned for elective PSF surgery from September 2015 to December 2015 were prospectively recruited into this study. All patients underwent a similar pain management regime with patient controlled anesthesia (PCA) morphine, acetaminophen, celecoxib, oxycodone hydrochloride.

RESULTS: A total of 40 patients (36F:4 M) were recruited. The visual analogue score (VAS) pain score was highest at 12 hours post-operation (6.0 ± 2.3). It reduced to 3.9 ± 2.2 (day 4), 1.9 ± 1.6 (day 7) and 0.7 ± 1.1 (day 14). The total PCA usage in all patients was 12.4 ± 9.9 mg (1 12 hours), 7.1 ± 8.0 mg (12 to 24 hours), 5.6 ± 6.9 (24 to 36 hours) and 2.1 ± 6.1 mg (36 to 48 hours). The celecoxib capsules usage was reducing from 215.0 ± 152.8 mg at 24 hours to 55.0 ± 90.4 mg on day 14. The acetaminophen usage was reducing from 2275 ± 1198 mg at 24 hours to 150 ± 483 mg at day 14. Oxycodone hydrochloride capsules consumption rose to the peak of 1.4 ± 2.8 mg on day 4 before gradually reducing to none by day 13.

CONCLUSIONS: With an adequate post-operation pain regime, significant pain should subside to a tolerable level by post-operative day 4 and negligible by post-operative day 7. Patient usually can be discharged on post-operative day 4 when the usage of PCA morphine was not required.