• Erdogan Mehmet Ali MA *Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey †Inonu University, School of Medicine, Departm, Ulku Ozgul, Muharrem Ucar, Mehmet Fatih Korkmaz, Mustafa Said Aydogan, Ozkan Ahmet Selim AS, Cemil Colak, and Mahmut Durmus.
• *Inonu University, School of Medicine, Department of Anaesthesiology and Reanimation, Malatya, Turkey †Inonu University, School of Medicine, Department of Orthopedics and Taumatology, Malatya, Turkey ‡Inonu University, School of Medicine, Department of Biostatistics, and Medical Informatics, Malatya, Turkey.
• Spine. 2017 Jun 15; 42 (12): 882-886.

Study DesignA prospective, randomized, double-blinded study.ObjectiveThe 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.Summary Of Background DataEpidural 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.MethodsForty-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.ResultsCumulative 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.ConclusionThe 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.Level Of Evidence2.

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