title: Continuous infusion of bupivacaine reduces postoperative morphine use in adolescent idiopathic scoliosis after posterior spine fusion.
abstract: METHODS
  Retrospective analysis.
  
  
  OBJECTIVE
  To determine if an infusion of bupivacaine will reduce the need for intravenous opioids following posterior spine fusion.
  
  
  BACKGROUND
  Adolescent idiopathic scoliosis is estimated to occur with a frequency of 1% to 3% among the at-risk age group of 10 to 18 years. A small percentage of these patients will require surgical intervention. Data are limited regarding continuous infusion of local anesthetic after posterior spine fusion for pain control. METHODS.: Retrospective review of children 10 to 18 years with idiopathic scoliosis admitted to a tertiary care, 20-bed pediatric intensive care unit (P pediatric intensive care unit), following posterior spine fusion. The primary outcome was postoperative opioid use stratified by the presence of a catheter for continuous bupivacaine. Secondary outcomes included pain scores, side effect management, depth of catheter placement, and fluid resuscitation.
  
  
  RESULTS
  Two hundred and forty-four children were eligible, 129 received a catheter for continuous bupivacaine, 115 did not. There were no differences in demographics. Significantly fewer patients receiving bupivacaine required a continuous basal infusion of morphine (32.6% vs. 85.2%, P < 0.001) resulting in an overall reduction opioid use on postoperative day 1 (18.9 vs. 26.4 mg, P < 0.001). Overall, pain scores were low in both groups. Limiting the analysis to only those with a bupivacaine catheter, the depth of catheter placement did not impact postoperative opioid use (P > 0.15).
  
  
  CONCLUSIONS
  The use of a continuous infusion of bupivacaine provided good analgesia with low pain scores. The significant reduction in basal morphine use may reflect a replacement by bupivacaine, although this is limited by potential treatment bias. Multivariate analysis was required to control for ongoing changes in anesthesia practice over the many years of the study. The optimal depth of catheter placement is unclear from this analysis and should be studied prospectively.
authors.affiliation: Division of Critical Care Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA, USA. pross@chla.usc.edu
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Ross
authors.forename: Brendan M
authors.initials: BM
authors.lastname: Smith
authors.forename: Vernon T
authors.initials: VT
authors.lastname: Tolo
authors.forename: Robinder G
authors.initials: RG
authors.lastname: Khemani
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D002045:Bupivacaine / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D015999:Multivariate Analysis; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control*; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D002045:Bupivacaine