Abstract:
Study Design. A prospective, randomized, double-blinded
study.
Objective. The aim of this study was to compare the efficacy
and side effects of patient-controlled intermittent bolus epidural
analgesia (PCIEA) and patient-controlled continuous epidural
analgesia (PCCEA) for postoperative pain control in adolescent
idiopathic scoliosis.
Summary of Background Data. Epidural analgesia is an
accepted efficacious and safe procedure for postoperative pain
management in scoliosis surgery. However, the PCIEA has not
been adequately investigated for postoperative pain control in
adolescent idiopathic scoliosis.
Methods. Forty-seven patients, 8 to 18 years of age, who were
undergoing posterior spinal fusion for idiopathic scoliosis were
randomized to either the PCIEA or PCCEA group. An epidural
catheter was inserted by a surgeon under direct visualization.
The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg
of morphine bolus, additional doses of 0.25 mL/kg morphine
with a 1-hour lockout given by patient-controlled demand, and
no infusion. The PCCEA group received the following: 0.2 mg/
mL morphine, an initial morphine loading set at 0.1 mL/kg,
followed by a 0.05 mL/kg/h continuous infusion of morphine,
and a 0.025 mL/kg bolus dose of morphine. There was a
30-minute lockout interval. The primary outcome was morphine
usage. The secondary outcomes were pain score, postoperative
nausea and vomiting, and pruritus.
Results. Cumulative morphine consumption was lower in the
PCIEA group than in the PCCEA group. Both methods provided
effective pain control. There were no differences in pain scores
between the groups. Postoperative nausea, vomiting, and pruritus
were lower in the PCIEA group.
Conclusion. The two epidural analgesia techniques studied are
both safe and effective methods for postoperative pain control
after posterior spinal fusion in idiopathic scoliosis. Nausea,
vomiting and pruritus were considerably higher in the PCCEA
group. Concerns regarding side effects associated with epidural
opioids can be avoided by an intermittent bolus with a relatively
lower amount of opioid.
