An Update on Pain Management in Pediatric Spine Surgery

AI Summary

Multimodal analgesia and ERAS protocols in paediatric spine surgery are essential to control pain, reduce opioid use, and minimise postoperative morbidity.
Regional and neuraxial techniques in paediatric spine surgery, including erector spinae plane blocks and intrathecal morphine, improve mobilisation and lower narcotic requirements.
Preoperative mental health, anxiety, and pain catastrophising predict higher postoperative pain; psychosocial interventions and comparative research on analgesic modalities are needed.

AI Summary

We aimed to summarize the data on preoperative pain management, intraoperative pain management, and postoperative pain management pathways for pediatric spine surgery. While patient-controlled anesthesia is currently widespread after pediatric spine surgery, there is increasing research on regional modalities for pain control, including erector spinae plane blocks, liposomal bupivacaine, epidural analgesia, and intrathecal morphine injections, which are associated with earlier mobilization and decreased narcotic use, with maintained or decreased pain scores. Multimodal pain control, as outlined in Enhanced Recovery After Surgery protocols, is necessary to achieve adequate pain control while decreasing narcotic usage and the associated side effects.

Basic summary

Curr Rev Musculoskelet Med. 2026 Jun 1;19(1):41. doi: 10.1007/s12178-026-10037-8.

ABSTRACT

PURPOSE OF REVIEW: This paper aims to provide an overview on current recommendations for perioperative pain control for pediatric spine surgery. Managing pediatric pain is important to decrease postoperative morbidity, improve early mobilization, and decrease narcotic analgesic use. We aimed to summarize the data on preoperative pain management, intraoperative pain management, and postoperative pain management pathways for pediatric spine surgery.

RECENT FINDINGS: Pre-operative mental health conditions have been shown to be associated with increased post-operative pain. Intravenous ketorolac and oral gabapentin use postoperatively can improve postoperative pain control and decrease opioid use. While patient-controlled anesthesia is currently widespread after pediatric spine surgery, there is increasing research on regional modalities for pain control, including erector spinae plane blocks, liposomal bupivacaine, epidural analgesia, and intrathecal morphine injections, which are associated with earlier mobilization and decreased narcotic use, with maintained or decreased pain scores. Multimodal pain control, as outlined in Enhanced Recovery After Surgery protocols, is necessary to achieve adequate pain control while decreasing narcotic usage and the associated side effects. Psychosocial factors can impact pain through anxiety and pain catastrophizing. There is increased emphasis on regional and neuraxial anesthesia modalities for pain control. Further research is needed directly comparing the effectiveness of these modalities and further exploring the effect of psychosocial factors on pain and methods to address this.

PMID:42219428 | DOI:10.1007/s12178-026-10037-8

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