Effect of a Surgeon-Directed Cocktail of Ropivacaine, Methylprednisolone, and Ketoprofen on Postoperative Pain and Ambulation in Adolescent Idiopathic Scoliosis Surgery: A Double-Blind Randomized Controlled Trial.

Study design: Double-blind randomized controlled trial.

Objective: To assess the safety and efficacy of surgeon-directed intraoperative subfascial cocktail analgesics in adolescent scoliosis surgery.

Summary of background data: Several studies have demonstrated the efficacy of intraoperative surgeon-directed analgesics in idiopathic scoliosis surgery. However, their retrospective analyses provided limited clinical evidence. Are cocktail analgesics effective in improving postoperative pain in idiopathic scoliosis surgery? Can surgeon-directed intraoperative cocktail analgesics improve postoperative pain scores and help patients ambulate?

Methods: Forty-two adolescent patients (mean age 15.8±2.1 years, 31 females) were randomly assigned to two groups: one receiving cocktail analgesics (21 patients), and the other serving as a control (21 patients). The cocktail consisted of 0.75% ropivacaine, methylprednisone, and ketoprofen. The primary outcome measured was postoperative pain (NRS). Secondary outcomes included ambulation timing, fentanyl and acetaminophen usage. Epidural anesthesia usage was recorded but not analyzed as an independent outcome since perceived pain severity may have influenced its administration.

Results: Forty-two patients (mean age: 15.8±2.1 years, 31 females) were included. Both groups had comparable baseline characteristics, including age, sex distribution, and preoperative curve severity. The cocktail group showed significantly lower pain scores 1 hour post-surgery (4.1±3.7 vs. 5.6±2.9, P=0.044) and ambulated earlier (2.5±0.5 vs. 3.3±2.5 days, P=0.049). However, there were no significant differences in pain scores after 6 hours or in fentanyl/acetaminophen consumption. Adverse events attributable to the procedures were comparable between both groups.

Conclusions: Surgeon-directed cocktail therapy alone is insufficient to achieve significant improvements in pain control, as evidenced by the minimal impact on NRS scores and early ambulation promotion. Clinically, this underscores the need for more comprehensive, multimodal pain management strategies to optimize postoperative recovery and enhance outcomes for patients with adolescent scoliosis.