title: Postoperative analgesia after anterior correction of thoracic scoliosis: a prospective randomized study comparing continuous double epidural catheter technique with intravenous morphine.
abstract: METHODS
  Prospective randomized comparative study of two techniques for postoperative analgesia.
  
  
  OBJECTIVE
  Assess the efficacy of two epidural catheters compared with intravenous morphine after anterior correction of thoracic scoliosis.
  
  
  BACKGROUND
  Spine surgery with anterior thoracotomy can cause severe postoperative pain. Continuous epidural analgesia through two epidural catheters was shown to be effective after posterior scoliosis correction. The efficacy of this technique has still not been demonstrated in this surgical context.
  
  
  METHODS
  Thirty adolescent patients with thoracic idiopathic scoliosis scheduled for anterior correction were prospectively randomized into morphine (M) or epidural (E) group. In the E group, two epidural catheters were placed transforaminally after scoliosis correction. The immediate postoperative analgesia was performed with remifentanil in all patients until the first postoperative morning (T0 = begin of study), when either continuous intravenous morphine (M group) or continuous epidural ropivacaine 0.3% (E group) was initiated. Pain at rest and in motion, morphine consumption, sensory level, motor blockade, nausea/vomiting, pruritus, bowel function, and patient satisfaction were assessed.
  
  
  RESULTS
  In the E group, there was significantly less pain at rest and in motion, less rescue morphine consumption, improved bowel activity, and higher patient satisfaction. The incidence of side effects was significantly higher in M group.
  
  
  CONCLUSIONS
  Two epidural catheters provide better postoperative analgesia with fewer side effects and higher patient satisfaction after anterior instrumentation of thoracic scoliosis.
authors.affiliation: Department of Anesthesiology, Balgrist Clinic, Zurich, Switzerland.
authors.forename: Stephan
authors.initials: S
authors.lastname: Blumenthal
authors.forename: Alain
authors.initials: A
authors.lastname: Borgeat
authors.forename: Marco
authors.initials: M
authors.lastname: Nadig
authors.forename: Kan
authors.initials: K
authors.lastname: Min
mesh_terms: D000293:Adolescent; D000577:Amides / Q000008:administration & dosage* / Q000009:adverse effects; D015360:Analgesia, Epidural / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local / Q000008:administration & dosage* / Q000009:adverse effects; D002404:Catheterization; D002648:Child; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011859:Radiography; D000077212:Ropivacaine; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery
chemical_list: D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077212:Ropivacaine