• Katharina Dinter, Henriette Bretschneider, Stefan Zwingenberger, Alexander Disch, Anne Osmers, Oliver Vicent, Falk Thielemann, Jens Seifert, and Peter Bernstein.
• UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine "Carl Gustav Carus" , TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. Katharina.Dinter@uniklinikum-dresden.de.
• Arch Orthop Trauma Surg. 2023 Jan 1; 143 (1): 301309301-309.

PurposePostoperative pain is a major concern following scoliosis surgery. CEA (continuous epidural analgesia) is established in postoperative pain therapy as well as intravenous patient-controlled analgesia (IV-PCA). The purpose of this study was to compare the clinical outcomes of both methods.MethodsWe retrospectively studied 175 children between 8 and 18 years who were subject to posterior scoliosis correction and fusion. Two main cohorts were formed: CEA with local anesthetic and opioids, and IV-PCA with opioids. Both groups further comprised two sub-cohorts: those who were mentally and/or physically healthy (H; n = 93 vs. n = 30) and those who were impaired (I; n = 26 vs. n = 26). The outcome parameters were the demand for pain medication, parameters of mobilization, and the presence of adverse reactions.ResultsHealthy children who received CEA started mobilization 1 day earlier than children with IV-PCA (p = 0.002). First postsurgical defecation was seen earlier in all children who received CEA in both groups (H; Day 4 vs. Day 5, p = 0.011, I; Day 3 vs. Day 5, p = 0.044). Healthy children who received CEA were discharged from hospital 4 days earlier than their IV-PCA counterparts (p < 0.001). No statistically significant difference in postoperative nausea nor in vomiting was identified between groups. Transient neurological irritations were seen in 9.7% of the patients in the CEA group.ConclusionsCEA provides appropriate pain management after scoliosis surgery, regardless of the patient's mental status. It allows earlier postoperative defecation for all patients , as well as shorter hospitalization and an earlier mobilization for healthy patients.© 2021. The Author(s).

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