{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T09:20:40Z","timestamp":1780564840526,"version":"3.54.1"},"reference-count":19,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T00:00:00Z","timestamp":1776297600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Enhanced Recovery After Surgery (ERAS) pathways are increasingly used in spine surgery, but uptake in adolescent idiopathic scoliosis (AIS) remains heterogeneous across institutions. Evidence in pediatric deformity surgery supports shorter recovery with protocolized care, yet real-world comparative data combining ERAS and the erector spinae plane block (ESPB) remain limited. This study aimed to compare early postoperative outcomes between a historical standard-care pathway and a structured ERAS+ESPB pathway in adolescents undergoing posterior spinal fusion for AIS. Materials and Methods: A single-center retrospective time-based comparative cohort study design included consecutive AIS patients (&lt;18 years) treated between 1 January 2024 and 31 December 2025. The standard-care pathway was applied to patients operated on before 1 June 2025 (n = 34), whereas the ERAS+ESPB pathway was applied to those operated on from 1 June 2025 onward (n = 35), following formal institutional implementation. Outcomes included postoperative pain assessed using the visual analog scale under two functional conditions\u2014at rest in the supine position and during standing\/mobilization\u2014at POD0, POD1, POD2, POD3, discharge, and 2-week follow-up; postoperative nausea at POD0\u2013POD3; and length of stay (LOS). Between-group pain comparisons used Welch\u2019s t-test; nausea used Fisher\u2019s exact test; LOS used the Wilcoxon rank-sum test. Results: At POD0, supine pain was lower in ERAS+ESPB (1.50 \u00b1 0.55) than in standard care (3.20 \u00b1 1.50; p &lt; 0.001). From POD1 onward, supine pain did not differ significantly between groups. Among assessable patients, standing pain was lower in ERAS+ESPB at POD2 (3.05 \u00b1 1.53 vs. 4.50 \u00b1 1.05; p = 0.020), POD3 (2.82 \u00b1 1.62 vs. 4.17 \u00b1 1.03; p = 0.006), and 2-week follow-up (1.45 \u00b1 0.80 vs. 2.26 \u00b1 0.93; p = 0.006). Nausea was lower in ERAS+ESPB at POD0 (11.4% vs. 35.3%; p = 0.024) and POD2 (8.6% vs. 32.4%; p = 0.018), with no significant differences at POD1 or POD3. LOS was shorter in ERAS+ESPB (5.41 \u00b1 1.10 vs. 8.32 \u00b1 2.06 nights; p &lt; 0.001). Conclusions: In adolescents undergoing posterior spinal fusion for AIS, an ERAS-based perioperative pathway incorporating ESPB was associated with improved early postoperative recovery, particularly in terms of immediate postoperative pain, pain during mobilization, early postoperative nausea at selected time points, and length of hospital stay. Prospective multicenter studies are needed to confirm these findings and clarify the independent contribution of individual pathway components.<\/jats:p>","DOI":"10.3390\/medicina62040775","type":"journal-article","created":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:14:46Z","timestamp":1776334486000},"page":"775","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Enhanced Recovery After Surgery Incorporating Erector Spinae Plane Block Versus Standard Care in Adolescent Idiopathic Scoliosis: A Comparative Cohort Analysis of Early Postoperative Recovery"],"prefix":"10.3390","volume":"62","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9111-3638","authenticated-orcid":false,"given":"Sergio","family":"De Salvatore","sequence":"first","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianmichele","family":"Di Cosimo","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, IRCCS, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8163-3787","authenticated-orcid":false,"given":"Paolo","family":"Brigato","sequence":"additional","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Inverso","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6933-0321","authenticated-orcid":false,"given":"Leonardo","family":"Oggiano","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sergio","family":"Sessa","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-0113-8852","authenticated-orcid":false,"given":"Davide","family":"Palombi","sequence":"additional","affiliation":[{"name":"Research Unit of Orthopaedic and Trauma Surgery, Department of Medicine and Surgery, Universit\u00e0 Campus Bio-Medico di Roma, Via Alvaro del Portillo, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Palmieri","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, IRCCS, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefano","family":"Guida","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, IRCCS, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Contursi","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Critical Care, IRCCS, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caterina","family":"Fumo","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cloe","family":"Curri","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastian","family":"Miccio","sequence":"additional","affiliation":[{"name":"Management and Diagnostic Innovations & Clinical Pathways Research Area, Neurorehabilitation and Adapted Physical Activity Day Hospital, Bambino Ges\u00f9 Children\u2019s Hospital, IRCCS, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"D\u2019Alessandro","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pier Francesco","family":"Costici","sequence":"additional","affiliation":[{"name":"Orthopedic and Traumatology Unit, Department of Surgery, Bambino Ges\u00f9 Children\u2019s Hospital, 00165 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1527","DOI":"10.1016\/S0140-6736(08)60658-3","article-title":"Adolescent idiopathic scoliosis","volume":"371","author":"Weinstein","year":"2008","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"15030","DOI":"10.1038\/nrdp.2015.30","article-title":"Adolescent idiopathic scoliosis","volume":"1","author":"Cheng","year":"2015","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"327\u2013333; quiz 334\u2013335","DOI":"10.1097\/NOR.0000000000000007","article-title":"Young people\u2019s experiences with scoliosis surgery: A survey of pain, nausea, and global satisfaction","volume":"32","author":"Rullander","year":"2013","journal-title":"Orthop. Nurs."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1001\/jamasurg.2016.4952","article-title":"Enhanced Recovery After Surgery: A Review","volume":"152","author":"Ljungqvist","year":"2017","journal-title":"JAMA Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"729","DOI":"10.1016\/j.spinee.2021.01.001","article-title":"Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS\u00ae) Society recommendations","volume":"21","author":"Debono","year":"2021","journal-title":"Spine J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1016\/j.jspd.2016.01.001","article-title":"A Rapid Recovery Pathway for Adolescent Idiopathic Scoliosis That Improves Pain Control and Reduces Time to Inpatient Recovery After Posterior Spinal Fusion","volume":"4","author":"Gornitzky","year":"2016","journal-title":"Spine Deform."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"893","DOI":"10.1007\/s43390-021-00310-w","article-title":"Enhanced recovery after surgery (ERAS) in adolescent idiopathic scoliosis (AIS): A meta-analysis and systematic review","volume":"9","author":"Gadiya","year":"2021","journal-title":"Spine Deform."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"647","DOI":"10.1007\/s43390-025-01040-z","article-title":"Enhanced recovery after surgery for adolescent idiopathic scoliosis: A revised systematic review and meta-analysis","volume":"13","author":"Brigato","year":"2025","journal-title":"Spine Deform."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1659","DOI":"10.1007\/s43390-025-01145-5","article-title":"Safety and efficacy of erector spinae plane block for perioperative analgesia in posterior spinal fusion surgery for pediatric idiopathic scoliosis: A meta-analysis","volume":"13","author":"Alshahomi","year":"2025","journal-title":"Spine Deform."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1097\/BPO.0000000000000601","article-title":"Use of a Novel Pathway for Early Discharge Was Associated with a 48% Shorter Length of Stay After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis","volume":"37","author":"Fletcher","year":"2017","journal-title":"J. Pediatr. Orthop."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3457","DOI":"10.1007\/s00586-021-06984-0","article-title":"Comparison of interventions and outcomes of enhanced recovery after surgery: A systematic review and meta-analysis of 2456 adolescent idiopathic scoliosis cases","volume":"30","author":"Koucheki","year":"2021","journal-title":"Eur. Spine J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1007\/s43390-020-00282-3","article-title":"Short term outcomes of an enhanced recovery after surgery (ERAS) pathway versus a traditional discharge pathway after posterior spinal fusion for adolescent idiopathic scoliosis","volume":"9","author":"Fletcher","year":"2021","journal-title":"Spine Deform."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"e20151568","DOI":"10.1542\/peds.2015-1568","article-title":"Rapid Recovery Pathway After Spinal Fusion for Idiopathic Scoliosis","volume":"137","author":"Muhly","year":"2016","journal-title":"Pediatrics"},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Subramanian, T., Mazzucco, M., Subramanian, A., Mcgowen, S., Halayqeh, S., Zhao, E., Kaidi, A.C., Dekhne, M., Lovecchio, F.C., and Zhukovsky, M. (2025). Efficacy of Erector Spinae Plane Block in Pediatric Scoliosis Surgery: A Systematic Review and Meta-Analysis. Clin. Spine Surg.","DOI":"10.1097\/BSD.0000000000001959"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"3823","DOI":"10.1007\/s00586-024-08457-6","article-title":"Bilateral ultrasound-guided erector spinae plane block for postoperative analgesia in paediatric idiopathic scoliosis patients undergoing posterior spine fusion surgery: A randomized controlled trial","volume":"33","author":"Ren","year":"2024","journal-title":"Eur. Spine J."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1097\/BRS.0000000000005185","article-title":"Erector Spinae Plane Block with Liposomal Bupivacaine for Adolescent Idiopathic Scoliosis Surgery: No Patient-controlled Analgesia Needed","volume":"50","author":"Young","year":"2025","journal-title":"Spine (Phila Pa 1976)"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e23.00176","DOI":"10.2106\/JBJS.RVW.23.00176","article-title":"Nausea and Vomiting After Posterior Spinal Fusion in Adolescent Idiopathic Scoliosis: A Systematic and Critical Analysis Review","volume":"12","author":"Syed","year":"2024","journal-title":"JBJS Rev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1034\/j.1399-6576.2002.t01-1-460303.x","article-title":"Dimenhydrinate for prophylaxis of postoperative nausea and vomiting: A meta-analysis of randomized controlled trials","volume":"46","author":"Kranke","year":"2002","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1016\/j.jpedsurg.2023.10.020","article-title":"Does Chewing Gum Lead to Earlier Postoperative Gastrointestinal Recovery in Children? A Systematic Review and Meta-analysis","volume":"59","author":"Fung","year":"2024","journal-title":"J. Pediatr. Surg."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/775\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T10:41:15Z","timestamp":1776336075000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/62\/4\/775"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,16]]},"references-count":19,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["medicina62040775"],"URL":"https:\/\/doi.org\/10.3390\/medicina62040775","relation":{},"ISSN":["1648-9144"],"issn-type":[{"value":"1648-9144","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,16]]}}}