Posterior spinal fusion is one of the most common major surgical procedures performed in children and adolescents. Pain control can be challenging owing to the extensive posterior exposure and major tissue trauma. Therefore, a multimodal pain management is often necessary.

Pregabalin was originally developed for use as an anti-epileptic drug. It has been shown to have antinociceptive and neuroprotective effects, and the use in pre-emptive analgesia has increased worldwide. Pregabalin has been shown to reduce pain scores and opioid consumption after spine surgery in adult population. Thus, the study objective was to evaluate the effect of perioperative pregabalin on postoperative pain scores and oxycodone consumption in adolescents after posterior spinal fusion and to assess the effect of pregabalin on the intraoperative neurophysiological measurements. Multimodal pain management aims to reduce the need for opioids and reduce the adverse effects of high opioid use. One of these adverse effects is postoperative urinary retention. The fourth publication of this thesis evaluates the incidence of urinary retention in adolescents after spinal surgery.

The results of previous studies on the causal relationship between spinal deformities in children and back pain have been controversial. The traditional view is that deformities do not result in back pain. However, more recent studies suggest that spinal asymmetry and scoliosis are risk factors for back pain. Evidence of chronic pain after spinal surgery in children is sparse. The main goal of our third study was to evaluate the preoperative pain and to assess the prevalence of persistent postsurgical pain in children after spinal surgery.

In our study we showed that pregabalin did not affect the intraoperative neuromonitoring, postoperative opioid consumption or pain scores after spinal fusion. Children with scoliosis reported a moderate amount of pain prior to surgery and a reduction in pain after surgery. Compared to the healthy controls the back pain was similar in the surgically treated patients. Almost 50% of adolescents experience impaired bladder emptying after spinal surgery.