title: Patient-controlled Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis: Prospective, Randomized, Double-blinded Study.
abstract: METHODS
  A prospective, randomized, double-blinded study.
  
  
  OBJECTIVE
  The aim of this study was to compare the efficacy and side effects of patient-controlled intermittent bolus epidural analgesia (PCIEA) and patient-controlled continuous epidural analgesia (PCCEA) for postoperative pain control in adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  Epidural analgesia is an accepted efficacious and safe procedure for postoperative pain management in scoliosis surgery. However, the PCIEA has not been adequately investigated for postoperative pain control in adolescent idiopathic scoliosis.
  
  
  METHODS
  Forty-seven patients, 8 to 18 years of age, who were undergoing posterior spinal fusion for idiopathic scoliosis were randomized to either the PCIEA or PCCEA group. An epidural catheter was inserted by a surgeon under direct visualization. The PCIEA group received 0.2 mg/mL of morphine, 0.25 mL/kg of morphine bolus, additional doses of 0.25 mL/kg morphine with a 1-hour lockout given by patient-controlled demand, and no infusion. The PCCEA group received the following: 0.2 mg/mL morphine, an initial morphine loading set at 0.1 mL/kg, followed by a 0.05 mL/kg/h continuous infusion of morphine, and a 0.025 mL/kg bolus dose of morphine. There was a 30-minute lockout interval. The primary outcome was morphine usage. The secondary outcomes were pain score, postoperative nausea and vomiting, and pruritus.
  
  
  RESULTS
  Cumulative morphine consumption was lower in the PCIEA group than in the PCCEA group. Both methods provided effective pain control. There were no differences in pain scores between the groups. Postoperative nausea, vomiting, and pruritus were lower in the PCIEA group.
  
  
  CONCLUSIONS
  The two epidural analgesia techniques studied are both safe and effective methods for postoperative pain control after posterior spinal fusion in idiopathic scoliosis. Nausea, vomiting and pruritus were considerably higher in the PCCEA group. Concerns regarding side effects associated with epidural opioids can be avoided by an intermittent bolus with a relatively lower amount of opioid.
  
  
  METHODS
  2.
authors: Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
authors: Mehmet Ali
authors: MA
authors: Erdogan
authors: Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
authors: Ulku
authors: U
authors: Ozgul
authors: Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
authors: Muharrem
authors: M
authors: Ucar
authors: Inonu University, School of Medicine, Department of Orthopedics and Taumatology, Malatya, Turkey.
authors: Mehmet Fatih
authors: MF
authors: Korkmaz
authors: Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
authors: Mustafa Said
authors: MS
authors: Aydogan
authors: Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
authors: Ahmet Selim
authors: AS
authors: Ozkan
authors: Inonu University, School of Medicine, Department of Biostatistics, and Medical Informatics, Malatya, Turkey.
authors: Cemil
authors: C
authors: Colak
authors: Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey.
authors: Mahmut
authors: M
authors: Durmus
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D016058:Analgesia, Patient-Controlled / Q000379:methods*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion