Society for Pediatric Anesthesia Improvement Network Update

By Ty Muhly, MD; Janice Man, MD; Kesavan Sadacharam, MD; and Joe Cravero, MD

Greetings from the members of the Society of Pediatric Anesthesia Improvement Network (SPAIN).  Established in 2014 under the leadership of Joseph Cravero from Boston Children’s Hospital, SPAIN is a multi-institutional collaborative developed with the goal of systematically documenting the perioperative care and outcomes in children undergoing surgical procedures where anesthetic or pain management approaches are variable.  The group’s inaugural project was a two-year investigation of the management strategies and outcomes for patients undergoing minimally invasive repair of pectus excavatum (MIRPE).  Contributing institutions included the following:

  • Boston Children’s Hospital
  • Children’s Hospital of Philadelphia
  • Nationwide Children’s Hospital
  • Children’s Hospital of Colorado
  • Children’s Hospital at Dartmouth-Hitchcock
  • A.I. DuPont Hospital for Children
  • Children’s Hospital Los Angeles
  • Wolfson’s Children’s Hospital, Nemour’s Children’s Specialty Care
  • Johns Hopkins Charlotte R. Bloomberg Children’s Center
  • Texas Children’s Hospital
  • Mayo Clinic
  • Johns Hopkins All Children’s Hospital
  • Medical University of South Carolina

Our group collected data on 348 patients managed with a variety of management techniques including epidural catheter, paravertebral catheter, wound catheter, intrathecal morphine or no regional intervention (PCA with multimodal analgesia). We tracked outcomes including daily morphine consumption, daily pain scores, functional status, length of stay, as well as psychological outcomes at two weeks and three months after surgery.    We are in the final stages of publishing the results of in hospital recovery for each of the treatment groups.  For that report we provided a detailed description of the management strategies and the collected outcomes in terms of pain, opioid use, functionality, and time to hospital discharge.  

Additionally, we are drafting a manuscript describing the psychological outcomes for this patient population at two weeks and three months with comparison to the immediate perioperative outcomes.  Following publication of the manuscripts, we will provide a summary of our findings in the next newsletter.   

SPAIN is currently working to develop the next prospective study.  The group plans to systematically investigate pain and functional outcomes following ACL reconstruction in children.  Tentative primary outcome measures include opioid use in the perioperative period (POD 1-3, and up to six months after procedure).  Secondary outcome measures include pre/post psychosocial and trauma questionnaire scores, pain scores, and functional outcome scores (Lysholm and IKDC) validated in the orthopedics literature. 

We are interested in recruiting other institutions who manage pediatric patients for ACL reconstruction to participate in the study.  If you are interested in learning more and or participating please contact Janice Man (, Kesavan Sadacharam (, Joe Cravero (, or Ty Muhly ( 

The SPAIN group will be meeting at the SPA Annual Meeting in San Francisco, CA, October 12, 2018.  We hope so see you there.

Back to top