Spinal Fusion, Post-Op, Adolescent Idiopathic Scoliosis (AIS) — Post-Operative Day 1 — Clinical Pathway: Inpatient

Inpatient Clinical Pathway for Adolescent Idiopathic Scoliosis (AIS) Spinal Fusion Rapid Recovery — Inpatient

Post-operative Day 1

Goals

  • Analgesia — begin PO regimen, discontinue PCA by end of the day
  • Advance mobility
  • Remove Foley catheter
Pain Management
  • IV analgesia
    • Start at 0800:
      • Ketorolac IV q6hr — max 8 doses
    • Continue:
      • Hydromorphone PCA — pain team to stop in afternoon if tolerating PO analgesics
      • Hydromorphone rescue IV q3hr PRN for breakthrough pain
      • Nalbuphine IV q4hr PRN for itching
      • Ondansetron IV q8hr PRN for nausea/vomiting
    • Complete:
      • Acetaminophen IV — convert to PO
  • Oral analgesia
    • Start:
      • Acetaminophen PO q4hr PRN for mild pain
      • Oxycodone PO q4hr PRN for moderate pain when tolerating diet
    • Continue:
      • Diazepam PO q6hr PRN for muscle spasticity
Activity/PT
  • Log roll q2hrs and PRN until rolling independently
  • Start PT and OT daily
  • Start ambulation, OOB to chair TID
  • Use brace PRN, if ordered and available
Nutrition
  • Advance diet as tolerated
  • Discontinue IVF once patient tolerating clears — saline lock PIV
Tubes/Drains
  • Remove Foley by 1,000, due to void 8 hrs after Foley pull
  • Record drain output q8hrs
  • Reinforce incision site/drain dressings as needed
Respiratory
  • Incentive spirometry q2hrs while awake
Medication Management
Ordered by Orthopedic Team
  • Complete post-operative antibiotic prophylaxis as ordered
  • Transition famotidine to oral dosing
  • Bowel regimen
    • Start Miralax® 17 g daily
    • Continue senna nightly
    • Bisacodyl suppository PRN
  • Severe PONV rescue plan unresponsive to dexamethasone/ondansetron:
    • Consider fluid bolus: 10 ml/kg lactated ringers
    • Additional dexamethasone 0.1 mg/kg up to 4 mg IV over 15 mins (can give up to 2 doses post-op)
Laboratory
  • 0600 phlebotomy round: CBC (no diff), type and screen
  • 2 view EOS scoliosis X-ray – complete as able to tolerate before discharge if not obtained intraoperatively
Discharge Planning
  • Assess home health and transportation needs