From the FDA Drug Label
Initiate treatment in a dosing range of 0.2 mg to 1 mg every 2 to 3 hours as necessary for pain control, and at the lowest dose necessary to achieve adequate analgesia. Intravenous administration should be given slowly, over at least 2 to 3 minutes, depending on the dose. Titrate the dose to achieve acceptable pain management and tolerable adverse events.
The recommended IV pain management drip for post scoliosis surgery is hydromorphone, with an initial dose range of 0.2 mg to 1 mg every 2 to 3 hours, administered slowly over 2 to 3 minutes. The dose should be titrated to achieve acceptable pain management and tolerable adverse events, with careful monitoring for signs of opioid-related adverse reactions 1.
- Key considerations:
- Use the lowest effective dosage for the shortest duration of time consistent with individual patient treatment goals.
- Titrate the dose based on the individual patient's response to their initial dose.
- Monitor carefully for signs and symptoms of withdrawal when discontinuing therapy.
From the Research
The most effective intravenous pain management regimen for post-scoliosis surgery is a multimodal approach that includes patient-controlled analgesia (PCA) with opioids, supplemented by scheduled IV acetaminophen, IV ketorolac, and low-dose ketamine infusion, as evidenced by the most recent and highest quality study 2.
Key Components of the Regimen
- Morphine PCA (1mg bolus with 6-minute lockout) or hydromorphone PCA (0.2mg bolus with 6-minute lockout) for the first 48-72 hours post-surgery
- Scheduled IV acetaminophen (15mg/kg, maximum 1000mg) every 6 hours
- IV ketorolac (0.5mg/kg, maximum 30mg) every 6 hours for the first 48 hours if there are no contraindications
- Low-dose ketamine infusion (0.1-0.2mg/kg/hr) to reduce opioid requirements and improve pain control
- Gabapentinoids like pregabalin (50-75mg twice daily) can be started preoperatively and continued postoperatively to address neuropathic pain components
Rationale
The chosen regimen is based on the study by 2, which demonstrated that a methadone-based multimodal analgesia protocol resulted in significantly lower length of hospital stay, improved pain control, and reduced total opioid consumption compared to a conventional regimen. This approach is also supported by other studies, such as 3 and 4, which highlight the benefits of multimodal analgesia and the importance of minimizing opioid use in post-scoliosis surgery patients.
Considerations
- Patients should be transitioned to oral pain medications after 2-3 days as they begin mobilization and rehabilitation
- Muscle relaxants such as IV diazepam (0.1mg/kg every 6 hours as needed) can be used to manage muscle spasms
- The regimen should be tailored to individual patient needs and medical history, with careful consideration of potential contraindications and side effects.