Wataru Saito1, Gen Inoue2, Takayuki Imura1, Tamie Takenami3, Masaki Ueno1, Toshiyuki Nakazawa1, Kentaro Uchida1, Naonobu Takahira4, Masashi Takaso1. 1. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan. 2. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan. Electronic address: ginoue@kitasato-u.ac.jp. 3. Department of Anesthesiology, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan. 4. Department of Orthopaedic Surgery, Kitasato University School of Medicine, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0374, Japan; Department of Rehabilitation, Kitasato University School of Allied Health Sciences, 1-15-1, Kitasato, Minami-ku, Sagamihara, Kanagawa 252-0373, Japan.
Abstract
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To identify the usefulness of epidural anesthesia for postoperative pain without opioid in respiratory-impaired children with neuromuscular scoliosis. SUMMARY OF BACKGROUND DATA: Safety and adequate postoperative pain control is the most important concern in respiratory-impaired children. In general, after a massively invasive operation analgesia is performed with continuous intravenous infusion of opioid. However, the opioid side effect of respiratory depression could be critical for these patients. METHODS: The authors compared a group of 5 patients with continuous epidural anesthesia (Epi[+]) and a group of 5 patients without epidural anesthesia (Epi[-]). Spinal correction was performed under general anesthesia. At the end of surgery, for patients in the Epi[+] group, an epidural catheter was inserted by a surgeon. Nonsteroidal anti-inflammatory medication was prescribed regularly for postoperative pain; additional medications were permitted following the same protocol in both groups. Via the epidural catheter, 0.2% ropivacaine was continuously infused at 4 to 6ml/hour for 3 days. The researchers compared the numeric rating scale, the frequency of use of an additional painkiller, the day patients were able to leave the bed, and the duration of the hospital stay. RESULTS: The numeric rating scale in the Epi[+] group was significantly lower than in the Epi[-] group each day; the frequency of using an additional painkiller was also lower in the Epi[+] group than the Epi[-] group. In addition, the researchers could find no complications including respiratory depression related to epidural anesthesia. CONCLUSIONS: Continuous epidural anesthesia could be effective and safe in children with neuromuscular scoliosis. It could control postoperative pain from scoliosis surgery without opioids, which may cause pulmonary depression. This pilot study indicates the need for further investigations to confirm the potential benefits of this method.
STUDY DESIGN: Retrospective comparative study. OBJECTIVE: To identify the usefulness of epidural anesthesia for postoperative pain without opioid in respiratory-impairedchildren with neuromuscular scoliosis. SUMMARY OF BACKGROUND DATA: Safety and adequate postoperative pain control is the most important concern in respiratory-impairedchildren. In general, after a massively invasive operation analgesia is performed with continuous intravenous infusion of opioid. However, the opioid side effect of respiratory depression could be critical for these patients. METHODS: The authors compared a group of 5 patients with continuous epidural anesthesia (Epi[+]) and a group of 5 patients without epidural anesthesia (Epi[-]). Spinal correction was performed under general anesthesia. At the end of surgery, for patients in the Epi[+] group, an epidural catheter was inserted by a surgeon. Nonsteroidal anti-inflammatory medication was prescribed regularly for postoperative pain; additional medications were permitted following the same protocol in both groups. Via the epidural catheter, 0.2% ropivacaine was continuously infused at 4 to 6ml/hour for 3 days. The researchers compared the numeric rating scale, the frequency of use of an additional painkiller, the day patients were able to leave the bed, and the duration of the hospital stay. RESULTS: The numeric rating scale in the Epi[+] group was significantly lower than in the Epi[-] group each day; the frequency of using an additional painkiller was also lower in the Epi[+] group than the Epi[-] group. In addition, the researchers could find no complications including respiratory depression related to epidural anesthesia. CONCLUSIONS: Continuous epidural anesthesia could be effective and safe in children with neuromuscular scoliosis. It could control postoperative pain from scoliosis surgery without opioids, which may cause pulmonary depression. This pilot study indicates the need for further investigations to confirm the potential benefits of this method.