Postoperative analgesia following surgical correction for adolescent idiopathic scoliosis: a comparison of continuous epidural analgesia and patient-controlled analgesia.
METHODS
A retrospective comparison of postoperative continuous epidural analgesia and patient-controlled analgesia following surgical treatment for adolescent idiopathic scoliosis.


OBJECTIVE
To compare the safety and efficacy of continuous epidural analgesia and patient-controlled analgesia following adolescent idiopathic scoliosis surgery.


BACKGROUND
The most commonly used pain management techniques are continuous epidural analgesia and patient-controlled analgesia. However, no large published reports compare them following adolescent idiopathic scoliosis surgery.


METHODS
A review was performed from 1990 to 2001 of patients undergoing primary surgery for adolescent idiopathic scoliosis. Visual analog scale scores were recorded postoperatively at multiple time periods. Adverse effects related to each pain management technique were noted.


RESULTS
The average of all pain scores (1.3 vs. 1.9) (P < 0.0001) and scores at 2, 4, 6, 8, 12, 24, 36, and 48 hours (p < 0.001) was significantly better in the continuous epidural analgesia group when compared to the patient-controlled analgesia group. The range of pain scores (2.3 vs. 2.7) (P < 0.05) and the average maximum score was less in the continuous epidural analgesia group (2.6 vs. 3.2) (P < 0.05). The need to temporarily stop and then restart the pain management (12.3% vs. 7.0%) (P = 0.04) and premature permanent discontinuation (13.1% vs. 0.0%) (P < 0.001) was greater in the continuous epidural analgesia group than the patient-controlled analgesia group. No neurologic injuries occurred.


CONCLUSIONS
Although both continuous epidural analgesia and patient-controlled analgesia provide effective pain control following surgery for adolescent idiopathic scoliosis, patients with continuous epidural analgesia had significantly better pain scores for all time periods, less fluctuations in pain, and lower maximum pain levels during the postoperative period.
Sucato
Daniel J
DJ
Texas Scottish Rite Hospital, Dallas, Texas, USA. dan.sucato@tsrh.org
Duey-Holtz
Allison
A
Elerson
Emily
E
Safavi
Fay
F
D000293:Adolescent; D015360:Analgesia, Epidural; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000627:therapeutic use; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011184:Postoperative Period; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D004091:Hydromorphone; D002045:Bupivacaine