Postoperative analgesia after anterior correction of thoracic scoliosis: a prospective randomized study comparing continuous double epidural catheter technique with intravenous morphine.

STUDY DESIGN: Prospective randomized comparative study of two techniques for postoperative analgesia.

OBJECTIVE: Assess the efficacy of two epidural catheters compared with intravenous morphine after anterior correction of thoracic scoliosis.

SUMMARY OF BACKGROUND DATA: Spine surgery with anterior thoracotomy can cause severe postoperative pain. Continuous epidural analgesia through two epidural catheters was shown to be effective after posterior scoliosis correction. The efficacy of this technique has still not been demonstrated in this surgical context.

METHODS: Thirty adolescent patients with thoracic idiopathic scoliosis scheduled for anterior correction were prospectively randomized into morphine (M) or epidural (E) group. In the E group, two epidural catheters were placed transforaminally after scoliosis correction. The immediate postoperative analgesia was performed with remifentanil in all patients until the first postoperative morning (T0 = begin of study), when either continuous intravenous morphine (M group) or continuous epidural ropivacaine 0.3% (E group) was initiated. Pain at rest and in motion, morphine consumption, sensory level, motor blockade, nausea/vomiting, pruritus, bowel function, and patient satisfaction were assessed.

RESULTS: In the E group, there was significantly less pain at rest and in motion, less rescue morphine consumption, improved bowel activity, and higher patient satisfaction. The incidence of side effects was significantly higher in M group.

CONCLUSIONS: Two epidural catheters provide better postoperative analgesia with fewer side effects and higher patient satisfaction after anterior instrumentation of thoracic scoliosis.