Feasibility and efficacy of preoperative epidural catheter placement for anterior scoliosis surgery.
BACKGROUND
Postoperative pain control via thoracic epidural catheters (TECs) is an important aspect of postoperative care, and ample evidence highlights its positive physiologic effects and superiority to intravenous analgesia. If epidural catheters for postoperative pain relief are used in scoliosis surgery, current practice is the intraoperative placement of the TEC by the surgeon because preoperative placement is considered challenging and dangerous. On the basis of magnetic resonance imaging of scoliotic spines, the authors developed a technique for preoperative placement of TEC and investigated its safety and feasibility.


METHODS
Patients undergoing anterior scoliosis surgery were included, who received preoperative placement of TEC. Postoperative pain, problems associated with the TEC placement, possible side effects, radiographic data, and insertion levels of the TEC were noted.


RESULTS
The apex vertebra was identified as a possible site for TEC placement due to dural sac shift leaving a wider epidural space on the convex side. Scoliosis-induced rotation of the vertebrae required realignment of the needle toward the convex side. Sixty patients were included. The success rate for TEC placement was 96.6%: one failed attempt, one catheter placed intrapleurally, and one patient with Horner syndrome. Seven percent of patients required additional rescue analgesia. All other patients had pain scores within acceptable limits (Visual Analogue Scale <5).


CONCLUSIONS
The authors have demonstrated that it is possible to insert a TEC in patients with scoliotic spines with a high degree of success using a redesigned approach and thus provide adequate postoperative analgesia with a single epidural catheter. However, precautions have to be taken.
Wenk
Manuel
M
Department of Anaesthesia and Pain Medicine, Royal Perth Hospital, Perth, Western Australia, Australia. manuelwenk@mac.com
Ertmer
Christian
C
Weber
Thomas P
TP
Liljenqvist
Ulf R
UR
Pöpping
Daniel M
DM
Möllmann
Michael
M
Bullmann
Viola
V
D000293:Adolescent; D000767:Anesthesia, Epidural / Q000295:instrumentation* / Q000379:methods; D002045:Bupivacaine / Q000008:administration & dosage; D002408:Catheters, Indwelling; D002648:Child; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000295:instrumentation*; D010149:Postoperative Pain / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D011300:Preoperative Care / Q000295:instrumentation* / Q000379:methods; D011859:Radiography; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D002045:Bupivacaine