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-controlled analgesia (PCA) in 50 patients after surgical correction of adolescent idiopathic scoliosis with respect to certain postoperative parameters. Objectives. To compare postoperative parameters after posterior spinal instrumentation and fusion (PSIF) and to determine whether epidural infusion prolongs hospital stay or increases the risk of complications. Summary of Background Data. Patient-controlled analgesia and epidural infusion are both safe and effective in controlling postoperative pain after PSIF. One criticism of epidural infusion has been longer hospital stays. No study was found in the literature in which PCA was compared with epidural infusion. 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. Postoperative parameters including the day that each patient tolerated a full diet, day of independent ambulation, length of hospital stay, and pain control were compared. Results. Pain control was comparable in each group. The epidural group tolerated a full diet earlier and on average were discharged 0.5 days sooner than the PCA group, Both differences are statistically significant. No significant complications were reported in either group. Conclusions. Epidural infusion of opioids with bupivacaine is safe and effective for controlling postoperative Pain after PSIF without an increased complication rate when compared with PCA. In the current study, patients tolerated a full diet and were discharged from the hospital an average of 0.5 days earlier than PCA-treated patients.