Double epidural catheter with ropivacaine versus intravenous morphine: a comparison for postoperative analgesia after scoliosis correction surgery.
BACKGROUND
Major spine surgery with a dorsal or ventrodorsal approach causes severe postoperative pain. The use of continuous epidural analgesia through one or two epidural catheters placed intraoperatively by the surgeon has been shown to provide efficient postoperative pain control. In this prospective unblinded study, the authors compared the efficacy of continuous intravenous morphine with a continuous double epidural catheter technique with ropivacaine after scoliosis correction.


METHODS
Thirty patients with American Society of Anesthesiology physical status I-III were prospectively randomized to either the morphine group or the epidural group. At the end of surgery, patients in the epidural group received two epidural catheters placed by the surgeon, one directed cephalad and one caudally. Correct placement was checked radiographically. Postoperative analgesia until the first postoperative morning was performed with remifentanil target-control infusion for all patients. From that time remifentanil was stopped and continuous intravenous analgesia with morphine or double epidural analgesia with ropivacaine 0.3% was initiated (T0 = beginning of study). Pain at rest and pain in motion (using a visual analog scale from 0-100), the amount of rescue analgesics, sensory level, motor blockade, postoperative nausea and vomiting, and pruritus were assessed every 6 h and bowel function was assessed every 12 h until T72 (end of study). Two days later, patient satisfaction was assessed.


RESULTS
Pain scores at rest were significantly decreased in the epidural group at all time points except at T12, T60, and T72. Pain scores in motion were significantly decreased in the epidural group at T24, T48, and T72. Bowel activity was significantly better in the epidural group at T24, T36, T48, and T60. Postoperative nausea and vomiting and pruritus occurred significantly less frequently in the epidural group. No complications related to the epidural catheter occurred.


CONCLUSIONS
Both methods provide efficient postoperative analgesia. However, double epidural catheter technique provides better postoperative analgesia, earlier recovery of bowel function, fewer side effects, and a higher patient satisfaction.
Blumenthal
Stephan
S
Department of Anesthesiology, Orthopedic University Hospital Balgrist, Zurich, Switzerland.
Min
Kan
K
Nadig
Marco
M
Borgeat
Alain
A
D000293:Adolescent; D000328:Adult; D000577:Amides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D015360:Analgesia, Epidural / Q000009:adverse effects / Q000295:instrumentation*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002404:Catheterization; D002648:Child; D005260:Female; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D016343:Monitoring, Intraoperative; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D019637:Orthopedic Procedures; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced / Q000453:epidemiology; D000077212:Ropivacaine; D012600:Scoliosis / Q000601:surgery*
D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine