1. 2022;25;E589-E596Postoperative Pain in Adolescent Idiopathic Scoliosis Surgery: A Randomized Controlled Trial
   Randomized Controlled Trial
   Nur Canbolat, MD, Irem Basaran, MD, Demet Altun, MD, Turgut Akgul, MD, and Mehmet I. Buget, MD.

BACKGROUND: Adolescent idiopathic scoliosis (AIS) is the most common type of scoliosis, and its treatment is essentially surgical for curves above 40 degrees. Posterior spinal instrumentation (PI) is the usual technique, while the vertebral body tethering (VBT) method is tested technique for this study as a new treatment option.

OBJECTIVES: To compare postoperative pain outcomes between PI and VBT with mini-thoracotomy surgeries performed in AIS patients.

STUDY DESIGN: Prospective, randomized controlled study registered with the Clinical Trials Portal (NCT04822935).

SETTING: Department of Anesthesiology.

METHODS: We randomly divided 31 adolescents (28 women, 3 men) aged 11 to 18, with a diagnosis of AIS into 2 groups using computer software: the PI and the VBT groups. Postoperative morphine consumption and the Numeric Pain Rating Scale (NRS) scores at the 1st, 4th, 8th, 12th, 24th, and 48th hours and at 4 weeks were recorded. Length of hospital stays, length of intensive care unit (ICU) stays, duration of operation, postoperative patient satisfaction with the Likert scale, and complications such as bleeding and respiratory distress were recorded. Preoperative and follow-up Oswestry Disability Index (ODI) questionnaires were obtained to assess patient outcomes at 4 weeks postoperatively.

RESULTS: Postoperative morphine consumption and the NRS scores at the 1st, 4th, 8th, 12th, 24th, and 48th hours were significantly higher in group VBT (P < 0.05). The amount of bleeding was significantly higher in group PI (P = 0.002). The ICU and the hospital length of stays in the VBT group were significantly higher (respectively, P = 0.011; P = 0.032). Discharge NRS scores, ODI scores as well as patients’ satisfaction were similar in both groups (P > 0.05).

LIMITATIONS: Firstly, this was a single-centered study with a small sample owing to the rarity of AIS surgeries. Moreover, double-blinding was not applied to the patients and doctors because of the surgery incision places.

CONCLUSION: From our results, both techniques can be employed for AIS surgery, but a meticulous approach is essential for the prevention of acute pain for VBT.

KEY WORDS: Adolescent idiopathic scoliosis, posterior spinal instrumentation, postoperative pain, mini-thoracotomy, spine