title: Epidural analgesia for postoperative pain control after adolescent spinal fusion procedures which violated the epidural space.
abstract: METHODS
  Retrospective chart review.
  
  
  OBJECTIVE
  To determine the effectiveness of epidural analgesia in scoliosis patients with an opened (violated) spinal canal.
  
  
  BACKGROUND
  Postoperative continuous epidural analgesia using local anesthetics and/or opioids has been described with good success after posterior scoliosis correction. One of the concerns with the use of epidural catheters for pain control is the reliability and distribution of analgesic medication when the epidural space is violated intraoperatively by Smith-Petersen osteotomies or placement of multiple sublaminar wires.
  
  
  METHODS
  The medical records of 55 patients who underwent pediatric deformity surgery for scoliosis at a single university center over 1-year period (January 2007 to January 2008) were reviewed. Patient demographic, surgical, and postoperative data were collected. A chi test was used to make comparisons on the basis of categorical data, whereas analysis of variance tests were used to make comparisons on the basis of means. Statistical significance was defined as a probability value of <0.5.
  
  
  RESULTS
  Twenty-nine patients were managed with epidural analgesia, whereas 26 patients were managed with intravenous patient-controlled analgesia (IV PCA). Seven of the 29 patients with epidural analgesia had a violation of their epidural space during their surgery, which did not alter the efficacy of their postoperative analgesia with an epidural. Epidural analgesia provided a lower mean pain score (P=0.022) over the first 24 hours and fewer pain scores over 4 (P=0.050) during that same time period than IV PCA for all patients as well as those with a violated spinal canal. There was no statistical difference in the rates of pruritus, nausea, ileus, constipation, urinary retention, change in neurologic examination, or rate of infection between the patients with a violated spinal canal and those with an intact spinal canal.
  
  
  CONCLUSIONS
  Overall, patients managed with an epidural had significantly lower pain scores than those managed with IV PCA despite violation of the epidural space.
authors.affiliation: Department of Anesthesia and Pediatrics, SUNY Upstate Medical Center, 4143 UH, 750 East Adams St., Syracuse, NY 13210, USA. bethdemers@yahoo.com
authors.forename: Elizabeth Demers
authors.initials: ED
authors.lastname: Lavelle
authors.forename: William F
authors.initials: WF
authors.lastname: Lavelle
authors.forename: Ryan
authors.initials: R
authors.lastname: Goodwin
authors.forename: David
authors.initials: D
authors.lastname: Gurd
authors.forename: Thomas
authors.initials: T
authors.lastname: Kuivila
authors.forename: George
authors.initials: G
authors.lastname: Youssef
authors.forename: Julie
authors.initials: J
authors.lastname: Niezgoda
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D004824:Epidural Space / Q000187:drug effects* / Q000601:surgery*; D006801:Humans; D016268:Internal Fixators / Q000009:adverse effects; D010027:Osteotomy / Q000009:adverse effects; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy* / Q000517:prevention & control; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000601:surgery*; D013115:Spinal Canal / Q000000981:diagnostic imaging / Q000601:surgery; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery; D016896:Treatment Outcome