Background
Methodology
Intravenous PCA
First author Journal Year Type of study Total sample size | Loading | PCA bolus | Lockout interval | Basal infusion |
---|---|---|---|---|
Weldon [14]
Clin J Pain
1993 RCT 54 | None | Morphine sulfate 0.03 mg/kg (PCA bolus alone) or 0.02 mg/kg (PCA bolus + basal infusion) | None (PCA bolus alone) or morphine sulfate 0.02 mg/kg/h (PCA bolus + basal infusion) | |
Beaulieu [15]
Int Orthop
1996 Observational 100 | Morphine 114.5 μg/kg | Morphine 24.8 μg/kg | 9.9 min | None |
Cassady [16]
Reg Anesth Pain Med
2000 RCT 33 | None | Morphine sulfate 0.02 mg/kg | 8-min and 4-h limit of 0.2 mg/kg | None |
Munro [17]
Can J Anaesth
2002 RCT 35 | Morphine 0.05–0.1 mg/kg | Morphine 0.02 mg/kg | No description | Morphine 0.01 mg/kg/h |
Sucato [18] Spine (Phila Pa 1976) 2005 Retrospective 613 | None | Morphine 0.02–0.03 mg/kg or meperidine 0.2–0.3 mg/kg | 7–12 min with a limit of 4–5 injections/h | ± Morphine 0.015 mg/kg/h or meperidine 0.15 mg/kg/h |
Crawford [19]
Anesth Analg
2006 RCT 30 | Morphine 100 μg/kg | Morphine 20 μg/kg | 6 min | Morphine 10 μg/kg/h |
Gauger [20]
J Pediatr Orthop
2009 RCT 67 | None | Hydromorphone 2 μg/kg | 10-min and 4-h limit of 20 μg/kg | Hydromorphone 2 μg/kg/h |
Milbrandt [21] Spine (Phila Pa 1976) 2009 Retrospective 136 | None | Morphine 0.01–0.02 mg/kg | 6–10 min with a limit of 4–5 injections/h | ± Morphine 0.02 mg/kg/h |
Sadhasivam [22]
J Clin Anesth
2009 Retrospective 131 | None | Morphine 20 μg/kg | 7 min | Morphine 10 μg/kg/h |
Wade [23]
Spine Deform
2015 Retrospective 196 | None | Morphine 10 μg/kg | 10 min | Morphine 10 μg/kg/h |
Mayell [24]
Pediatr Anaesth
2014 RCT 35 | None | Morphine 20 μg/kg | 6 min | Morphine 10 μg/kg/h for the first day |
Klatt [25] Spine (Phila Pa 1976) 2013 RCT 66 | Up to 0.2 mg/kg | Morphine 20 μg/kg | 10 min with a limit of 4 demand doses/h | Morphine 20 μg/kg/h |
Choudhry [26]
J Pediatr Orthop
2017 Retrospective 127 | None | Morphine 1.0 mg | 10 min with a 4-h maximum dose of 0.3 mg/kg | Morphine 20 μg/kg/h |
Perello [27] Spine (Phila Pa 1976) 2017 RCT 44 | None | Morphine hydrochloride 20 μg/kg | Morphine hydrochloride 5 μg/kg/h | |
Pestieau [28]
Pediatr Anesth
2014 RCT 50 | None | Morphine 20 μg/kg | 8 min | Morphine 20 μg/kg/h |
Rusy [29]
Anesth Analg
2010 RCT 59 | None | Morphine 0.02 mg/kg | 6 min and an hourly maximum of 0.12 mg/kg | Morphine 0.02 mg/kg/h |
Engelhardt [30]
Anesth Analg
2008 RCT 34 | None | Morphine 20 μg/kg | 6 min | Morphine 10 μg/kg/h |
O’Hara [31]
Pediatr Anesth
2004 RCT 31 | None | Morphine 1 mg (BW > 50 kg) or 20 μg/kg (BW < 50 kg) | 6 min with 10 possible doses/h | None |
Hiller [32] Spine (Phila Pa 1976) 2012 RCT 36 | None | Oxycodone 0.025 mg/kg | 10-min and 4-h maximum of 0.3 mg/kg | None |
Epidural analgesia
First author Journal Year Type of study Total sample size | Catheter position | Loading | Continuous infusion | PCEA |
---|---|---|---|---|
Cassady [16]
Reg Anesth Pain Med
2000 RCT 33 | At the midpoint of the incision and advanced 3–5 cm cephalad | Bupivacaine 0.25% with epinephrine 1:200,000, 10 ml, 15 min before skin closure | Bupivacaine 0.125% (0.35 mg/kg/h) and fentanyl 2.5 μg/ml (0.7 μg/kg/h), 0.28 ml/kg/h, within 30 min of arrival in the PACU | None |
Tobias [42]
Paediatr Anaesth
2001 Observational 14 | Upper catheter: at the T6–8 level with the tip directed cephalad to T1–4. Lower catheter: at the T12 level with the tip directed caudad to the L1–4 level. | Fentanyl 1 μg/kg and hydromorphone 5 μg/kg were diluted in 0.3 ml/kg of saline. Following placement, the upper and lower catheters were dosed with 0.1 ml/kg and 0.2 ml/kg of the solution, respectively. After tracheal extubation and neurologic examination, the catheters were dosed with 0.1 ml/kg of ropivacaine 0.2% (upper catheter) and 0.2 ml/kg of ropivacaine 0.2% (lower catheter) | Ropivacaine 0.1% and hydromorphone 10 μg/ml at 0.1 ml/kg/h into the upper catheter and 0.2 ml/kg/h into the lower catheter, started after the bolus doses of ropivacaine | None |
Blumenthal [40]
Anesthesiology
2005 RCT 30 | Upper catheter: at the cranial end of the wound and the tip directed 4–5 cm cephalad to T1–4. The lower catheter was inserted at the caudal end of the wound, and the tip was directed 4–5 cm to a position at L1–4. | Ropivacaine 0.3% 4–8-ml boluses through each catheter. | Ropivacaine 0.3% 4–10 ml/h in each catheter after the bolus doses of ropivacaine | None |
O’Hara [31]
Paediatr Anaesth
2004 RCT 31 | At the midpoint of the incision and advanced 3–5 cm cephalad | Bupivacaine 0.1% or 0.065% + fentanyl 5 μg/ml, 3 ml, before conclusion of surgery | Bupivacaine 0.1% or 0.065% + fentanyl 5 μg/ml, 4 ml/h, after the bolus of epidural solution before conclusion of surgery | None |
Saudan [41] Paediatr Anaesth 2008 Observational 98 | Single: the catheter tip was in the center of the surgical site. Double: the cranial catheter was set between thoracic levels T4 and T6 and the lower catheter between T10 and L1 | Bupivacaine 0.25% with epinephrine 1:200,000 as a test dose after surgery. Bupivacaine 0.125%, 1.6 ml/kg as a loading dose in the absence of adverse events. | Bupivacaine 0.0625%, fentanyl 1 μg/ml, and clonidine 0.6 μg/ml, 0.2 ml/kg/h, in the recovery area | Doses of 0.1 ml/kg/h. Lockout time: 15 min, a maximal hourly bolus rate, 2 |
Gauger [20]
J Pediatr Orthop
2009 RCT 38 | At the midpoint of the incision and advanced 3–5 cm cephalad | Fentanyl 1 μg/kg and hydromorphone 5 μg/kg diluted in 0.3 ml/kg of saline, intraoperatively | Bupivacaine 0.1% + hydromorphone 10 μg/ml, 8 ml/h, on arrival in the PACU and after a neurologic examination | Bolus dose of 2 ml allowed every 30 min |
Klatt [25] Spine (Phila Pa 1976) 2013 RCT 66 | Single: at the midpoint of the incision and advanced 3–5 cm cephalad Double: the upper catheter was placed at the junction of the proximal and middle thirds of the instrumented spine and advanced 5 cm cephalad. The lower catheter was placed at the junction of the middle and distal thirds of the instrumented spine and advanced 5 cm cephalad. | Bupivacaine 0.1% and fentanyl 2 μg/ml, 0.2 ml/kg (single) or 0.1 ml/kg in each catheter (double), with initiation of wound closure | Bupivacaine 0.1% + fentanyl 2 μg/ml, 0.2 ml/kg/h (single) or bupivacaine 0.1% + fentanyl 2 μg/ml, 0.1 ml/kg/h in each catheter (double), upon arrival to the PACU | Demand dose of 0.1 ml/kg, lockout time 1 h (allowed only via the caudal catheter in the double catheter group) |
Erdogan [43] Spine (Phila Pa 1976) 2017 RCT 44 | At the midpoint of the incision and advanced 5–6 cm cephalad to T4 to T5 | Morphine 50 μg/kg in a PCIEA group and 20 μg/kg in a PCCEA group | No continuous infusion in the PCIEA group and morphine 10 μg/kg/h in the PCCEA group | 50 μg/kg/h with a 1-h lockout in PCIEA group and 5 μg/kg bolus dose with a 30-min lockout interval and 4-h limit of 4 mg |
Intrathecal opioids
First author Journal Year Type of study Total sample size | Timing of administration | Solution | Site | Needle |
---|---|---|---|---|
Goodarzi [45]
Paediatr Anaesth
1998 RCT 80 | After tracheal intubation | 2 μg/kg morphine mixed with 50 μg of sufentanil and 2 ml of preservative-free saline | At the level of L3–4 | A 24-gauge spinal needle |
Gall [46]
Anesthesiology
2001 RCT 30 | After tracheal intubation | 4-ml solution containing 2 μg/kg preservative-free morphine, 5 μg/kg preservative-free morphine, or normal saline | No description | A 25-gauge pencil-point spinal needle |
Eschertzhuberl [47]
Br J Anaesth
2008 RCT 42 | After tracheal intubation | A mixture of 1 μg/kg sufentanil and 5 or 15 μg/kg morphine diluted with normal saline to a total volume of 3 ml | At the level of L3–4 or L4–5 | A 25-gauge pencil-point spinal needle |
Tripi [48] Spine (Phila Pa 1976) 2008 Retrospective 407 | After induction of general anesthesia and before surgical incision | No dose, moderate dose; morphine 9–19 μg/kg or high dose ≥ 20 μg/kg | No description | No description |
Son-Hing [49]
J Pediatr Orthop
2011 Retrospective 287 | After induction of general anesthesia and before surgical incision | Morphine 9–19 μg/kg | No description | No description |
Hong [50]
Paediatr Anaesth
2017 Retrospective 40 | Immediately after induction of anesthesia and prior to incision | Morphine 12 μg/kg | No description | No description |
Cohen [51]
Anesth Analg
2017 RCT 71 | After placement of an endotracheal tube | Preservative-free morphine at a concentration of 7.5 μg/kg | Between levels L2 and L5 | A 24-gauge spinal needle |
Ketamine
First author Journal Year Type of study Total sample size | Loading dose | Intraoperative infusion | Postoperative infusion |
---|---|---|---|
Engelhardt [30]
Anaesth Analg
2008 RCT 34 | 0.5 mg/kg (no description regarding the time of bolus administration) | 4 μg/kg/min started after bolus dose and discontinued after surgery at the time of tracheal extubation | None |
Pestieau [28]
Paediatr Anaesth
2014 RCT 50 | 0.5 mg/kg immediately after the patient was positioned prone | 0.25 mg/kg/h | 0.1 mg/kg/h infused for 72 h |
Minoshima [54]
Acta Anaesthesiol Scand
2015 RCT 36 | 0.5 mg/kg after tracheal intubation | 2 μg/kg/min started after loading dose | 2 μg/kg/min for 48 h |
Perello [27] Spine (Phila Pa 1976) 2017 RCT 44 | 0.5 mg/kg at induction of anesthesia | 2 μg/kg/min | 2 μg/kg/min for 72 h |
Gabapentinoids
First author Journal Year Type of study
n
| Preoperative dose | Postoperative doses |
---|---|---|
Mayell [24]
Paediatr Anaesth
2014 RCT 35 | 600 mg 1 h before surgery | None |
Rusy [29]
Anaesth Analg
2010 RCT 59 | 15 mg/kg 25–30 min before being taken to the OR | At a dose of 5 mg/kg three times/day, starting on POD 1 for 5 days |
Choudhry [26]
J Pediatr Orthop
2017 Retrospective 127 | 10 mg/kg up to a maximum of 600 mg 1 h before going to the OR | 200 mg twice a day for patients > 50 kg body weight and 100 mg three times a day for patients < 50 kg body weight starting on POD 1 until discharge from hospital |
Acetaminophen/nonsteroidal anti-inflammatory drugs
First author Journal Year Type of study Total sample size | Initial dose | Subsequent doses |
---|---|---|
Hiller [32] Spine (Phila Pa 1976) 2012 RCT 36 | Acetaminophen 30 mg/kg IV for 15 min at the time of surgical closure | Subsequent doses of acetaminophen were given 8 and 16 h after the first dose |
Munro [17]
Can J Anaesth
2002 RCT 35 | Ketorolac 0.5 mg/kg IV on completion of surgery | Repeat dosing of ketorolac every 6 h for a total of six doses |
Rosenberg [59] Spine (Phila Pa 1976) 2016 Retrospective 7349 | No description regarding dose and timing of ketorolac administration | No description regarding dose and timing of ketorolac administration |
Continuous wound infiltration
First author Journal Year Type of study Total sample size | Position of the catheter | Loading dose | Continuous infusion |
---|---|---|---|
Ross [67] Spine (Phila Pa 1976) 2011 Retrospective 244 | Just adjacent to the spinal instrumentation, in the paraspinal muscle, in the subfascial area, or subcutaneously at the discretion of the surgeon | None | Bupivacaine 0.5% at 4 ml/h for 100 h |
Reynolds [68]
Global Spine J
2013 Retrospective 87 | Two catheters inserted into the subcutaneous tissue on either side of the incision site, just before wound closure | None | Bupivacaine 0.25% in sterile saline at a rateof 4 ml/h (2 ml/h for each catheter) for 100 h |
Wade [23]
Spine Deform
2015 Retrospective 196 | Subcutaneously in the wound before closure | None | Bupivacaine 0.25% at 4 ml/h for 72 h |