Recovery From Surgery for Spina Bifida Occulta and Tethered Cord Syndrome in Children

Postoperative Orders 

• Standard care unit: The child is typically kept flat for 3 days after surgery. Pain control is important, and the care setting should reflect this need. Routinely, patients are kept in the pediatric intensive care unit for pain control needs.
• VS: Frequent (hourly) neuro-vital signs should be obtained for the immediate postoperative period (approximately 12 hours). Frequent wound checks should be completed for the first several days to ensure no CSF leak is present.
• Foley catheter: The Foley catheter is left in place until the patient is mobilized on postoperative day 3.
• HOB, positioning, activity, bathing: The patient is kept in a flat position for 3 days postoperatively. The patient is allowed to turn side to side and may lie prone. However, the head may not be elevated at any time.
• Medications and dosages including PRN drugs: Morphine PCA is routinely used in patients old enough to utilize a PCA system. Otherwise PRN morphine, diezepam, and sedation may be used for postoperative pain management. Utilization of a pediatric pain specialist or pediatric intensivist is ideal.
• Physical therapy and orthotics: On postoperative day 3 physical therapy and occupational therapy are used to mobilize the patient and provide ambulation support. Early physical therapy evaluation also provides an opportunity to arrange for home health care and physical therapy as needed.

Postoperative Morbidity

• Pain: Postoperative morbidity is primarily in the form of pain control. At the authors’ institution pediatric patients are managed by the pediatric intensive care service for pain control. The use of muscle relaxation as well as diazepam in the postoperative period is very effective.