A review of intrathecal and epidural analgesia after spinal surgery in children.

In view of the overall experience regarding regional anesthetic techniques to control postoperative pain in infants and children, it is feasible that a similar efficacy and safety profile can be obtained when using such techniques after major orthopedic procedures such as anterior or posterior spinal fusion. I reviewed previous reports regarding the use of neuraxial techniques to provide analgesia after spine surgery in the pediatric population. Variations in both the surgical procedure and the analgesic technique may make the comparison among studies somewhat impractical. Variations of the analgesic technique include 1). the dose of the medications used; 2). the route of delivery (intrathecal or epidural); 3). the mode of delivery (single dose, intermittent bolus dosing, and continuous infusion); 4). the number of epidural catheters used (one versus two); 5). the medications infused (opioids, local anesthetics, or both); 6). the opioid used (morphine, fentanyl, hydromorphone); and 7). the analgesic regimen of the control group (intermittent "as needed" morphine or patient-controlled analgesia). Although limited data are available to document the analgesic superiority of these techniques over parenteral opioids, clinical data offer evidence of other benefits, including decreased intraoperative blood loss and quicker return of gastrointestinal function.