Post-Operative Epidural Analgesia for Spine Fusion in Adolescent Idiopathic Scoliosis, Current Utilization at Spine Centers

Shriners Hospitals for Children, Spokane, WA, USA

PURPOSE:
The purpose of this study is to evaluate the current utilization of epidural analgesia for post-operative pain control in scoliosis fusion surgery. Secondly, to report a technique, findings, complications, and side effects of epidural analgesia for post-operative pain control in patients undergoing spinal fusion for adolescent idiopathic scoliosis (AIS) with a newly described intra-operative catheter insertion technique at our institution.

METHODS:
A questionnaire was sent to 60 Spine Surgeons regarding their use and experience with epidural analgesia for AIS spinal fusion. We performed a retrospective chart review of 50 consecutive patients that underwent spinal fusion for AIS at our institution since a new epidural catheter insertion technique was developed. Continuous epidural infusion with Dilaudid was performed.

RESULTS:
The response rate was 70% (42 of 60 questionnaires). Epidural analgesia is not utilized by 67% (28 of 42) of the respondents. A pain service was utilized by 93% (13 of 14) using epidural analgesia, and 61% (17 0f 28) using PCA. No respondents reported epidural catheter advancement > 10cm from the point of insertion. Surgeons site various reasons for not using epidural analgesia, including their belief that patient controlled analgesia (PCA) is superior for post-operative analgesia, the concern of complications and/or technical difficulties. Our review of 50 consecutive AIS patients, resulted in no reports of intra/post-operative complications related to the epidural catheter, including dural leaks or deep wound infections. The average epidural catheter tip was advanced > 10cm cephalad from the point of insertion. There were no therapeutic failures, respiratory arrests or respiratory depression requiring reversal. There were no neurological injuries, paraparesis or paraplegia reported. Minor side effects including itching and nausea were noted in 68% (34 of 50) patients, with resolution of symptoms with appropriate intervention.

CONCLUSIONS:
Epidural analgesia for post-operative pain control in spinal fusion for adolescent idiopathic scoliosis is safe and effective. A large number of spine specialists do not utilize epidural analgesia for post-operative pain control, despite numerous reports in the literature-documenting efficacy, safety, and earlier return of bowel function when compared to PCA. The technique we describe allows insertion of the epidural catheter tip without difficulty, and permits advancement of the catheter in the epidural space more than 10cm from the point of insertion. The efficacy reported at our center with no catheter complications, may be a direct result of this newly described technique.