Katharina Dinter1, Henriette Bretschneider2, Stefan Zwingenberger2, Alexander Disch2, Anne Osmers3, Oliver Vicent3, Falk Thielemann2, Jens Seifert4, Peter Bernstein2,4. 1. 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. 2. UniversityCenter for Orthopaedic, Trauma and Plastic Surgery , University Comprehensive Spine Center, University Medicine "Carl Gustav Carus" , TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 3. Department of Anesthesiology and Intensive Care Medicine, University Hospital "Carl Gustav Carus", TU Dresden, Fetscherstrasse 74, 01307, Dresden, Germany. 4. Department of Spine Surgery, AKG Klinik Hohwald GmbH, Hospital for Orthopaedics and Rheumatology, Hohwaldstraße 40, 01844, Neustadt in Sachsen, Germany.
Abstract
PURPOSE: Postoperative 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. METHODS: We 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. RESULTS: Healthy 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. CONCLUSIONS: CEA 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.
PURPOSE:Postoperative 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. METHODS: We 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. RESULTS: Healthy 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. CONCLUSIONS:CEA 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.
Authors: Joshua W B Klatt; Jennie Mickelson; Man Hung; Simon Durcan; Chris Miller; John T Smith Journal: Spine (Phila Pa 1976) Date: 2013-09-01 Impact factor: 3.468
Authors: Benjamin D Martin; Sophie R Pestieau; Jessica Cronin; Heather Gordish-Dressman; Karen Thomson; Matthew E Oetgen Journal: Spine Deform Date: 2020-01-20