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Pediatric Orthopaedic Practitioners Society POPS

Question from POPS member Amanda McCullough

Posted 7 months ago by Suzanne Hilt

POPS Member Amanda McCullogh would like your thoughts on the following question:

What is everyone using for post-operative pain and spasm control, specifically in your VDRO population? We have one surgeon who likes to use valium, and one that likes to use robaxin. We are having a hard time finding literature/research on using robaxin in young kids. I wanted to see what other facilities were doing. We usually use a combo of a narcotic, Tylenol (if using oxy), possibly NSAID and then either valium or robaxin. I appreciate the feedback-thanks! (Amanda, Jackson MS)


Colleen Ditro 6 months ago

Hi-We use valium, valium and more valium. We scheduled it RTC for the first 48hrs and then switch to prn. We also use hydrocodone or oxy with Tylenol. Occasionally, NSAIDS.

Jamie Cloyes 6 months ago

Hi! We also use valium with hydrocodone usually, and NSAIDS as well.

Melisa Johnston 6 months ago

We prescribe valium, oxycodone and recommend Tylenol/ibuprofen as well after VRDO procedures and also for other osteotomies with CP kids. My surgeon does a lot of CP surgery and had never heard of using Robaxin post op in this patient populations

Amanda Mccullough 6 months ago

Thanks for the feedback so far! Yes, the surgeon that prefers valium essentially has an all CP population and prefers valium. With the bigger push lately for the "no benzo and opiate combo", we were talking about different options.

Suzanne Hilt 5 months ago

We always use valium for spasm control. Initially scheduled every 6 hours and then PRN.

Anne Stuedemann 5 months ago

Great query Amanda,
We typically place these children on an epidural (containing clonidine and ropivacaine) for the from POD 0-POD2. If they are greater than 20kg we will place a 0.1mg clondine patch the night before transition off the epidural. With the clonidine patch placed, we then use the combo of hydrocodone/acetaminophen and Valium to control pain and spasms after transition off the epidural. We have had great success with Clonidine as an adjunct therapy in controlling neuropathy/pain which in turn decreases spasms. If children are under 20kg (or if a 0.1mg patch causes hypotension) we will assess the need, then put them on oral clonidine with the transition off epidural (1mcg/kg/dose q12hrs). Great question!

Amanda Mccullough 5 months ago

That is very interesting about the clonidine patch-thanks for the feedback!

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