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The current study aims to find the role of Enhance Recovery Pathway (ERP) as a multidisciplinary approach aimed to expedite rapid recovery, reduce LOS, and minimize morbidity associated with Non Fusion Anterior Scoliosis Correction (NFASC) surgery. A retrospective analysis of 35 AIS patients who underwent NFASC with Lenke 1 and Lenke 5 curves with a minimum of 1 year of follow-up was done. Patient demographics, surgical details, postoperative analgesia, mobilization, length of stay (LOS), patient satisfaction survey score with respect to information and care, and 90 days complications were collected. The cohort included 34 females and 1 male with a mean age of 15.2 years at the time of surgery. There were 16 Lenke 1 and 19 Lenke 5 in the study. Mean preoperative major thoracic and thoracolumbar/lumbar Cobb's angle were 52˚±7.6˚ and 51˚±4.5˚ respectively. Average blood loss and surgical time were 102 ±6.4 ml and 168 ± 10.2 mins respectively. Average time to commencing solid food was 6.5±1.5 hrs. Average time to mobilization following surgery was 15.5± 4.3 hrs. The average duration to the stopping of the epidural was 42.5±3.5 hrs. The average dose of opioid consumption intraoperatively was 600.5±100.5 mcg of fentanyl i.v. and 12.5±4.5 mg morphine i.v. Postoperatively opioids were administered via an epidural catheter at a dose of 2 mg of morphine every 24 hours up to 2 days and an infusion of 2mcg/hr of fentanyl along with 0.12-0.15% ropivacaine. The average duration to transition to oral analgesia was 55.5±8.5 hrs .20 patients had urinary catheter and the average time to removal of the catheter was 17.5±1.4 hrs. 25 patients had a chest tube and the average time to remove of chest tube was 25.5±3.2 hrs. The average length of hospital stay was 3.1±0.5 days. No patient had postoperative ileus or requirement of blood transfusion or any other complications. No correlation was found between LOS and initial cobb angle. The application of ERP in AIS patients undergoing NFASC results in reduced LOS and indirectly the cost, reduced post-operative opioid use, and overall improve patient satisfaction score


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_11 | Pages 120 - 120
1 Jul 2014
Chan E Blyth F Nairn L Fransen M
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Summary Statement. There were significant differences in the pain experience, behaviors, and perceptions on analgesics, between the Australia and Singapore cohorts, after hospital discharge following TKR. These findings may be influenced by the ethnicity and cultural differences between these two countries. Introduction. In recent years the hospital length of stay after total knee replacement (TKR) has shortened. Hence, patients have to self-manage their pain earlier after the surgery. The aim of this study was to examine if the pain experience, self-management behaviors and potential barriers to optimal analgesia after hospital discharge for TKR differed in different ethnicity groups. Patients & Methods. We administered a questionnaire to patients undergoing TKR in 10 Australian hospitals, and one large Singaporean hospital, two weeks following hospital discharge.1 We asked participants about their pain severity, use of analgesics, side-effects, perceptions of analgesics use, and satisfaction with pain relief at home. The two groups were compared using Chi-squared test with SPSS 20.0 with statistical significance set at p < 0.05. Results. 171 (98%) participants from the Australian centers and 105 (94%) from the Singaporean hospital completed the questionnaire. Compared with the Singaporean patients, significantly more participants in the Australian cohort reported that their worst pain period occurred during the first two weeks at home (52% vs. 20%, p < 0.0001), and that their average pain at home was ‘severe/extreme’ (23% vs. 6%, p < 0.0001). More participants in the Australian cohort consumed an opioid alone or in combination with non-opioid analgesics (69% vs. 33%, p < 0.0001). Although many in both cohorts experienced analgesic-related side-effects, the proportion was higher in the Australian cohort (84% vs. 41%, p < 0.0001). A very much larger proportion of participants in the Australian cohort sought further medical help for their pain (60% vs. 3%, p < 0.0001). A much small proportion of patients in the Australian cohort perceived that analgesics could not control pain (26% vs. 44%, p = 0.002); were concerned about addiction (26% vs. 42%, p = 0.005) or developing tolerance to analgesics (28% vs. 49%, p < 0.0001); or preferred enduring pain than analgesic-related side-effects (25% vs. 42%, p < 0.002). There was no significant difference in satisfaction with analgesia between the two cohorts (64% vs. 74%, p = 0.179). Discussion/Conclusion. Following hospital discharge for TKR, there were differences in the pain experience, opioid consumption, side-effects, and perceptions of analgesics, between the Australian and Singaporean cohorts. Ethnic or cultural differences might have influenced the differences found, as the Australian cohort mostly comprised of Caucasians while the Singaporean cohort comprised exclusively patients of Asian origin. Interestingly, despite more participants in the Australian cohort experiencing severe pain and higher incidence of analgesic-related side-effects, the proportion who were satisfied with analgesia during the first two weeks after hospital discharge were similar, suggesting that satisfaction is a complex concept influenced by the interplay of many factors. Future studies are required to examine the extent to which ethnicity and cultural factors determine the pain intensity, behaviours and perceptions reported by patients after TKR