A comparison of the effects of patient-controlled analgesia with intravenous opioids versus epidural analgesia on recovery after surgery for idiopathic scoliosis

Study Design. Epidural infusion was compared with standard patient-controll ed analgesia (PCA) in 50 patients after surgical correction of adolescent i diopathic scoliosis with respect to certain postoperative parameters. Objectives. To compare postoperative parameters after posterior spinal inst rumentation and fusion (PSIF) and to determine whether epidural infusion pr olongs hospital stay or increases the risk of complications. Summary of Background Data. Patient-controlled analgesia and epidural infus ion are both safe and effective in controlling postoperative pain after PSI F. One criticism of epidural infusion has been longer hospital stays. No st udy was found in the literature in which PCA was compared with epidural inf usion. Methods, The records of 50 consecutive patients who had undergone PSIF were reviewed. The epidural group consisted of 30 patients and the PCA group 20 , Age, weight, degree of curve, and levels fused were evenly matched. Posto perative parameters including the day that each patient tolerated a full di et, day of independent ambulation, length of hospital stay, and pain contro l were compared. Results. Pain control was comparable in each group. The epidural group tole rated a full diet earlier and on average were discharged 0.5 days sooner th an the PCA group, Both differences are statistically significant. No signif icant complications were reported in either group. Conclusions. Epidural infusion of opioids with bupivacaine is safe and effe ctive for controlling postoperative Pain after PSIF without an increased co mplication rate when compared with PCA. In the current study, patients tole rated a full diet and were discharged from the hospital an average of 0.5 d ays earlier than PCA-treated patients.