Postoperative pain control using epidural catheters after anterior spinal fusion for adolescent scoliosis

Study Design. A prospective review of patients undergoing epidural catheter placement after anterior spinal fusion and instrumentation for adolescent scoliosis was performed. Data were collected using visual analog pain scores reflecting the patients ' perception of their pain control. Objectives. To present the authors' technique for epidural catheter placeme nt and dosing protocol, and to demonstrate the results from postoperative p ain control after anterior spinal instrumented fusion for 10 consecutive pa tients. Summary of Background Data. The literature regarding the benefits of epidur al catheters after spinal surgery is contradictory, even with controlled st udies comparing epidural catheters with intravenous morphine patient-contro lled anesthesia. The authors believe that this lack of consensus stems from varied epidural dosing protocols and techniques in catheter placement, whi ch they have witnessed anecdotally at their own institution. This prompted the authors to develop and refine a standardized dosing and catheter placem ent protocol for pain control after spinal surgery. Methods. Epidural catheters were placed intraoperatively before wound closu re, then removed on postoperative Day 5. Dosing consisted of fentanyl (1 mu g/kg) and hydromorphone (5 mug/kg) diluted in preservative-free saline (0.2 mL/kg). After surgery, dosing consisted of 0.1% ropivacaine and hydromorph one (10 mug/ml) continuously infused at 0.2 ml-/kg/hour. Postoperative pain control was assessed on each postoperative day using a visual analog pain scale with choices ranging from 0 to 10. Results. The arithmetic mean of the median pain scores after surgery was 2. 1. The mean of the maximum pain scores for the 5 days was 4.1. Three patien ts required an epidural bolus and a 20% increase in the epidural infusion r ate. One patient was judged to be excessively sleepy, so the epidural infus ion rate was decreased by 20%. Pruritus requiring diphenhydramine developed in three patients. No other adverse effects related to epidural analgesia were noted. No catheters were accidentally pulled out or disconnected. Conclusion. By following the dosing protocol described, epidural catheters can be used safely and effectively to control postoperative pain after ante rior instrumentation and spinal fusion for adolescent scoliosis.