Surgical correction of scoliosis in children is crucial for preventing disease progression and lung function deterioration. However, factors such as bone trauma, impaired circulation, and soft tissue edema contribute to significant postoperative pain, potential complications, including chronic pain syndromes. This study aimed to compare three approaches to postoperative pain management in a pediatric population. We conducted a randomized controlled trial involving 60 children aged 10 to 17 years undergoing posterior spinal fusion surgery. Participants were assigned to one of three groups: Group 1 (n=20) received transdermal fentanyl combined with continuous epidural analgesia using a local anesthetic; Group 2 (n=20) received only epidural analgesia; Group 3 (n=20) - intravenous (IV) narcotic analgesics. Pain severity using the Visual Analog Scale (VAS), noninvasive hemodynamic parameters (blood pressure and heart rate), patient activity levels, POTR were evaluated every four hours during the first 72 hours postoperatively to assess effectiveness. Results: Group 1 achieved superior pain relief, with an average VAS score of 1.8 ± 0.07, significantly lower than Group 2 (3.06 ± 2.0) and Group 3 (5.06 ± 2.0; U=1531.50, p<0.005). Intergroup comparisons of noninvasive hemodynamic parameters revealed no significant differences. The incidence of nausea and vomiting was 7% in Group 1, 13% in Group 2, and 33% in Group 3. Patients in Group 1 were able to sit and cough painlessly from the first postoperative day, unlike those in Groups 2 and 3 who demonstrated higher pain levels (ANOVA=201.2, p<0.005).

Conclusions: The combination of epidural local anesthetic administration and transdermal fentanyl delivery is the most effective postoperative analgesia approach for children undergoing spinal fusion surgery, improving pain management and patient mobility while reducing complications.

OlgaPulkina Head of the Pediatric Anesthesiology and Intensive Care Department at the Surgical Clinic of the Saint-Petersburg Phthisiopulmonology State Research Institute of the Russian Federation. Dr. Pulkina holds a Candidate of Medical Sciences degree and has authored over 25 publications, with an h-index of 2. She has extensive experience taking care of children with neurosurgical, oncological, and infectious diseases and is currently focused on orthopedic patients. Dr. Pulkina is a member of the European Society of Pediatric Anesthesiologists and the Society of Pediatric Anesthesiologists of Russia.