Postoperative pain management following scoliosis surgery.
OBJECTIVE
The control of pain after scoliosis surgery is a real challenge for the anesthesiologist. The first reason is that major spine surgery for correction of scoliosis deformation causes severe postoperative pain, and second that patients undergoing these operations are most often children or adolescents who are known to suffer from increased pain sensation compared with adults.


RESULTS
A multimodal postoperative pain therapy is a well established procedure to control the pain after scoliosis surgery. Recently, prospective, well controlled studies have emphasized the key role of regional techniques in this context. Epidural analgesia has shown significant benefits regarding pain score, bowel recovery and patients' satisfaction. However, different modes of epidural analgesia application have been performed. Several issues including local anaesthetic concentration and infusion rate, duration of application and number of catheters placed will be discussed. The safety concerns associated with this type of analgesia will also be emphasized.


CONCLUSIONS
Significant improvements have been made in the control of postoperative pain after correction of scoliosis deformation in recent years. The introduction of epidural analgesia has cleared the way for better analgesic techniques in this surgical context. Properly performed and assessed, the addition of epidural analgesia after scoliosis surgery is a safe and effective form of analgesia and the benefits far outweigh the risks.
Borgeat
Alain
A
Department of Anesthesiology, Orthopedic University Clinic Balgrist, Zurich, Switzerland. alain.borgeat@balgrist.ch
Blumenthal
Stephan
S
D000293:Adolescent; D000328:Adult; D015360:Analgesia, Epidural / Q000379:methods*; D002648:Child; D003131:Combined Modality Therapy / Q000379:methods; D006801:Humans; D010149:Postoperative Pain / Q000628:therapy*; D017060:Patient Satisfaction; D012600:Scoliosis / Q000601:surgery*; D016896:Treatment Outcome