Blood conservation and pain control in scoliosis corrective surgery: an online survey of UK practice.

Scott Bird (1) , Neil Mcgill (2)

1 Anaesthetics
2 Anaesthetics

There is a paucity of research in the peri-operative care of the scoliosis patient. We therefore postulated that there would be large differences in hospital care. We assessed this diversity using an online survey, with particular reference to pain control, thromboprophylaxis and blood conservation strategies. Anaesthetists specialising in scoliosis surgery in the U.K. were contacted via email, asking them if they would fill in a short email survey. Non responders were contacted a total of three times over a 6 month period. Of the 24 centres practicing paediatric and adolescent scoliosis surgery we received completed questionnaires from anaesthetists working in 21, a response rate of 88%. Blood Conservation 20 centres (95%) routinely cross-match blood. 17 centres (81%) routinely use cell salvage with a further 3 (14%) using it for specific cases only. Only 4 centres (19%) advocated normovolaemic heamodilution, with no centres surveyed using pre donated blood. Peri-operatively, 17 centres (81%) routinely used anti-fibrinolytics, all of whom use Tranexamic acid. Reported dosing regimes showed an even wider variation than previously reported (1) with loading doses varying between 2-100mg/kg and infusions varying from 3-10mg/kg/hr. Thromboprophylaxis 3 centres (14%) used TEDS only, 3 centres (14%) TEDS and foot pumps, 6 centres (29%) Foot pumps alone and 8 centres (38%) used no mechanical devices. Low molecular weight heparin was only used as part of a thromboprophylaxis regime in 6 centres (29%) with some centres prescribing it the night before, others post operatively on the day of surgery, some 24 hours post surgery and one centre on day 2. Pain Control Epidural analgesia is routinely used in 8 centres (38%), of which 3 centres (14%) place 2 catheters and 2 centres (10%) use patient controlled epidural analgesia, all continuing use into the post operative period. 4 centres (19%) use clonidine as an adjunct. Paravertebral blocks are used in 9 centres (43%), some with postoperative infusions. Three centres each (14%) use intercostal nerve blockade or spinal opiods. All respondents use patient controlled analgesia (PCA), most commonly morphine but also fentanyl and oxycodone. Ketamine infusions are used in three centres (14%). Non steroidal anti inflammatory drugs were avoided by three centres (86%). Regular paracetamol was prescribed routinely in 12 centres (57%) and all but 2 (90%) centres use remifentanyl peri-operatively. Conclusion The results from our survey show wide variation in blood conservation, thromboprophylaxis and pain control techniques in scoliosis correction surgery in the U.K. National multi-centred research is required to define what is best practice. Key words: Survey, Anaesthetic practice, paediatric, scoliosis surgery, blood loss, pain control References 1. P.R. Smith, I. Crighton. BJA 2009; 103: 329P

Mots clés: Medicine

Scott Bird, Neil Mcgill. Blood conservation and pain control in scoliosis corrective surgery: an online survey of UK practice.. Pediatric Anesthesia, 2010, 21 (1), pp.50. ⟨10.1111/j.1460-9592.2010.03443.x⟩. ⟨hal-00600131⟩