Epidural analgesia for postoperative pain control after adolescent spinal fusion procedures which violated the epidural space.

STUDY DESIGN: 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.