Comparison of opioid-free versus traditional opioid-containing postoperative pain management pathways for idiopathic scoliosis

While opioid medications are commonly used to manage postoperative pain in patients undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis, their use is associated with negative short and long-term effects. There is a paucity of data evaluating the feasibility and efficacy of opioid-free pain regimens in this population. The purpose of this study was to compare a multimodal opioid-free with a traditional opioid-containing protocol in pediatric patients undergoing instrumented PSF for idiopathic scoliosis. We hypothesized that the opioid-free pain management pathway would result in equivalent length of stay (LOS) and fewer opioids prescribed at discharge compared with an opioid-containing pathway. This was a prospective case-control study comparing opioid-free versus opioid-containing pathways. Eligible participants included patients aged 10-20 years at time of surgery with idiopathic scoliosis who underwent primary instrumented PSF by a single, fellowship-trained pediatric orthopedic surgeon during a 2-year period. Total opioid use was recorded. Statistical analysis included Wilcoxon, Chi-square, and Fisher's exact tests for group comparisons. Patients in the opioid-free group had a greater number of levels fused ( P = 0.036), had a similar inpatient LOS postoperatively ( P = 0.917), and required fewer opioid prescriptions at discharge [10/36 patients (27.8%) vs. 55/56 patients (98.2%), respectively; P < 0.0001]. A comprehensive, multimodal, opioid-free pain management pathway following instrumented PSF for idiopathic scoliosis results in equivalent LOS and fewer opioids prescribed at discharge compared with an opioid-containing pathway. Establishing patient/family expectations beforehand is crucial to the successful engagement and implementation of this opioid-free protocol.