Document Detail

Pain Management in Patients With Adolescent Idiopathic Scoliosis Undergoing Posterior Spinal Fusion: Combined Intrathecal Morphine and Continuous Epidural Versus PCA.
MedLine Citation:
PMID:  23147623     Owner:  NLM     Status:  In-Data-Review    
STUDY DESIGN: : A retrospective case-comparison study.
OBJECTIVE: : Compare efficacy and safety of combined intrathecal morphine (ITM) and epidural analgesia (EPI) to that of conventional intravenous patient-controlled analgesia (IV-PCA) after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS).
SUMMARY OF BACKGROUND DATA: : Pain control after PSF in AIS has been managed traditionally with IV-PCA. More recently studies have shown improvement in pain control with the use of continuous EPI or intraoperative ITM. No studies to our knowledge have compared the use of both ITM and EPI analgesia to that of IV-PCA.
METHODS: : An Institutional Review Board-approved retrospective case-comparison study was performed from 1989 to 2009 of all patients undergoing PSF for AIS. Patients received either IV-PCA or ITM/EPI. Daily pain scores were recorded along with total opioid and benzodiazepine use. Adverse events were recorded for all the patients.
RESULTS: : A total of 146 patients were initially included in the study; 95 patients received ITM/EPI and 51 received IV-PCA as a historical control. Eight patients from the ITM/EPI group were excluded from the pain comparison portion of the study. There were no statistical differences in age, sex, weight, or hospital stay between the 2 groups. The ITM/EPI group had, on average, 1 additional level of fusion (P=0.001). Daily average pain scores were lower in the ITM/EPI group on all hospital days, and statistically lower in days 1 and 3 to 5. Total opioid requirement was significantly lower in the ITM/EPI patients, although oral opioid use was higher among this group. Total benzodiazepine use was lower among the IV-PCA group. A total of 15.7% of the IV-PCA patients had bladder hypotonia, compared with 1.1% of the ITM/EPI group (P=0.002). The rate of illeus was 15.7% in the IV-PCA patients and 5.7% in the ITM/EPI (P=0.071). Respiratory depression was reported in 4 ITM/EPI patients, 0 in our PCA group. Technical catheter malfunction was reported in 8.5% of the EPI group.
CONCLUSIONS: : The use of ITM/EPI after PSF for AIS is safe and effective, this methodology provided significantly lower pain scores and lowers total opioid use which can lead to urinary and bowel dysfunction.
Matthew Ravish; Bridget Muldowney; Aimee Becker; Scott Hetzel; James J McCarthy; Blaise A Nemeth; Kenneth J Noonan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of pediatric orthopedics     Volume:  32     ISSN:  1539-2570     ISO Abbreviation:  J Pediatr Orthop     Publication Date:  2012 Dec 
Date Detail:
Created Date:  2012-11-13     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8109053     Medline TA:  J Pediatr Orthop     Country:  United States    
Other Details:
Languages:  eng     Pagination:  799-804     Citation Subset:  IM    
Department of Orthopaedics and Rehabilitation, Department of Anesthesiology, School of Medicine and Public Health, American Family Children's Hospital, University of Wisconsin, Madison, WI.
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