Postoperative analgesia following surgical correction for adolescent idiopathic scoliosis: a comparison of continuous epidural analgesia and patient-controlled analgesia.

STUDY DESIGN: A retrospective comparison of postoperative continuous epidural analgesia and patient-controlled analgesia following surgical treatment for adolescent idiopathic scoliosis.

OBJECTIVES: To compare the safety and efficacy of continuous epidural analgesia and patient-controlled analgesia following adolescent idiopathic scoliosis surgery.

SUMMARY OF BACKGROUND DATA: The most commonly used pain management techniques are continuous epidural analgesia and patient-controlled analgesia. However, no large published reports compare them following adolescent idiopathic scoliosis surgery.

METHODS: A review was performed from 1990 to 2001 of patients undergoing primary surgery for adolescent idiopathic scoliosis. Visual analog scale scores were recorded postoperatively at multiple time periods. Adverse effects related to each pain management technique were noted.

RESULTS: The average of all pain scores (1.3 vs. 1.9) (P < 0.0001) and scores at 2, 4, 6, 8, 12, 24, 36, and 48 hours (p < 0.001) was significantly better in the continuous epidural analgesia group when compared to the patient-controlled analgesia group. The range of pain scores (2.3 vs. 2.7) (P < 0.05) and the average maximum score was less in the continuous epidural analgesia group (2.6 vs. 3.2) (P < 0.05). The need to temporarily stop and then restart the pain management (12.3% vs. 7.0%) (P = 0.04) and premature permanent discontinuation (13.1% vs. 0.0%) (P < 0.001) was greater in the continuous epidural analgesia group than the patient-controlled analgesia group. No neurologic injuries occurred.

CONCLUSIONS: Although both continuous epidural analgesia and patient-controlled analgesia provide effective pain control following surgery for adolescent idiopathic scoliosis, patients with continuous epidural analgesia had significantly better pain scores for all time periods, less fluctuations in pain, and lower maximum pain levels during the postoperative period.