A dual epidural catheter technique to provide analgesia following posterior spinal fusion for scoliosis in children and adolescents

Background: The authors report their experience with the use of a dual epid ural catheter technique in controlling pain following long posterior spinal fusion and instrumentation for scoliosis in children and adolescents. Methods: Following completion of the surgical procedure and prior to wound closure, the upper catheter was inserted with the tip directed cephalad to T1-4 while the tip of the lower catheter was positioned at the L1-4 level. As the surgical wound was being closed, the catheters were dosed with fenta nyl and hydromorphone followed by a continuous infusion of ropivacaine plus hydromorphone. Postoperative pain was assessed every 2-4 h using a visual analogue score or an observational behavioural score (0 = no pain, 10 = wor st imaginable pain). There were 14 patients ranging in age from 5-17 years (12.7 +/- 3.5) and in weight from 19-68 kg (44.3 +/- 17.5). The epidural ca theters were left in place until the fifth postoperative day. Results: The mean of the median pain score from each patient was 1.5 +/- 1. 6, 1.6 +/- 1.5, 1.4 +/- 1.3, 1.1 +/- 1.1 and 0.9 +/- 0.9, respectively, on postoperative days 1 through 5. The mean of the maximum pain scores was 3.5 +/- 2.3 (range 0-7), 4 +/- 1.6 (range 2-6), 3.1 +/- 1.7(range 1-6), 2.4 +/ - 1.5 (range 0-4) and 2.2 +/- 1.4 (range 0-4), respectively, on postoperati ve days 1 through 5. Conclusions: No adverse effects related to epidural analgesia were noted.