• Stephan Blumenthal, Alain Borgeat, Marco Nadig, and Kan Min.
• Department of Anesthesiology, Balgrist Clinic, Zurich, Switzerland.
• Spine. 2006 Jul 1;31(15):1646-51.

Study DesignProspective randomized comparative study of two techniques for postoperative analgesia.ObjectiveAssess the efficacy of two epidural catheters compared with intravenous morphine after anterior correction of thoracic scoliosis.Summary Of Background DataSpine surgery with anterior thoracotomy can cause severe postoperative pain. Continuous epidural analgesia through two epidural catheters was shown to be effective after posterior scoliosis correction. The efficacy of this technique has still not been demonstrated in this surgical context.MethodsThirty adolescent patients with thoracic idiopathic scoliosis scheduled for anterior correction were prospectively randomized into morphine (M) or epidural (E) group. In the E group, two epidural catheters were placed transforaminally after scoliosis correction. The immediate postoperative analgesia was performed with remifentanil in all patients until the first postoperative morning (T0 = begin of study), when either continuous intravenous morphine (M group) or continuous epidural ropivacaine 0.3% (E group) was initiated. Pain at rest and in motion, morphine consumption, sensory level, motor blockade, nausea/vomiting, pruritus, bowel function, and patient satisfaction were assessed.ResultsIn the E group, there was significantly less pain at rest and in motion, less rescue morphine consumption, improved bowel activity, and higher patient satisfaction. The incidence of side effects was significantly higher in M group.ConclusionsTwo epidural catheters provide better postoperative analgesia with fewer side effects and higher patient satisfaction after anterior instrumentation of thoracic scoliosis.

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