Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis
Intermittent Epidural Bolus Versus Epidural Infusion for Posterior Spinal Fusion After Adolescent Idiopathic Scoliosis
Patient-controlled Intermittent epidural bolus versus epidural infusion for posterior spinal
 fusion after adolescent idiopathic scoliosis.

 Scoliosis surgery is commonly performed in adolescent due to idiopathic scoliosis. It is
 reported that the postoperative pain after scoliosis surgery that occurs due to Surgical
 trauma and severe reflex muscle spasm be severe and excruciating. There are many methods for
 postoperative pain management. It is used often opioid , paracetamol and non-steroidal
 anti-inflammatory drug with patient- controlled intravenous analgesia (IV-PCA). In addition;
 intrathecal opioids, one catheter epidural with intermittent dosing bolus of morphine or
 continuous infusion (either opioids or local anaesthetics or both), double epidural catheter
 with continuous infusion and intravenous ketamine infusion were preferred other postoperative
 pain management models.

 Epidural analgesia is accepted procedure with the efficacy and safety profile for
 postoperative pain management in major orthopedic surgery including scoliosis surgery.
 Epidural analgesia techniques commonly have been used in continuous infusion of local
 anesthetics with or without opioid. It was emphasized that there was not adequate data in the
 literature to provide argument concerning the use of epidural opioids after spinal surgery.
 The objective of this study was to compare the effects and side effects patient- controlled
 intermittent bolus epidural analgesia (PCIEA) and patient- controlled continuous epidural
 analgesia (PCCEA) with morphine for postoperative pain control in adolescent idiopathic
 scoliosis after posterior spinal fusion.

 Methods The study was conducted after obtaining written consent from all patients and
 guardian, approval from the Inonu University Faculty of Medicine Ethics Committee. This
 prospective randomized controlled double-blinded study was conducted 47 patient between 8-18
 years, American Society of Anesthesia Classification (ASA) I-II, with idiopathic scoliosis,
 scheduled for elective posterior spinal fusion.

 Patients with a history of allergy to the drugs used in the study protocol, drug abused ,
 preoperative neurologic deficit, inability to use a visual analogue scale, pulmonary, cardiac
 and neuropsychiatric disorders were excluded. Exclusion criteria during the study were
 accidental perforation of dura, faulty epidural catheter placement, postoperative neurologic
 deficit or uncontrollable nausea, vomiting and pruritus.

 The patients who were not premedicated were instructed on the visual analog scale (VAS) and
 the patient-controlled analgesia (PCA) device that was implanted during the postoperative
 period.

 Patients were divided into two groups using the envelope drawing method. Patients who
 received epidural morphine with PCIEA represented Group 1, epidural morphine with PCCEA
 represented Group 2. The anesthetist who collected data and the patients were blinded.

 All operations were performed by the same surgical team. The posterior instrumentation with
 pedicle screws was applied to thoracic and lumbar spine. Epidural catheter was inserted by
 surgeon under direct visualization at the midpoint of the incision and advanced 5-6 cm
 cephalad to thoracic 4-5 before surgical closure. Intubated patients was taken to in the
 reanimation intensive care unit after operation, IV acetaminophen 15 mg / kg was started
 before extubation and repeated every 6 hours.

 After extubation and a neurological examination, patients in the PCİEA group received
 morphine 50 µg/kg in 10 mL bolus, lockout time 1 hour, no infusion. In Group 2, PCECA
 infusion the following initial setting loading morphine 0.02mg/kg in 8mL, was maintained 0.01
 mg/kg continuous infusion 4mL, 0.05 mg/kg 2mL bolus dose. 30 minute lock-out interval. 4 hour
 limit was 4 mg/kg.

 Pain score, morphine usage, postoperative nausea and vomiting, pruritus, rate their
 satisfaction ,sedation scores and motor block were assessed by researchers who were blinded
 to the study groups at postoperatively 2., 4., 6., 8., 12., 18., ve 24.hour, in all patients.
Scoliosis surgery is reported that the postoperative pain after scoliosis surgery that occurs
 due to Surgical trauma and severe reflex muscle spasm be severe and excruciating. There are
 many methods for postoperative pain management as opioid , paracetamol and non-steroidal
 anti-inflammatory drug with patient- controlled intravenous analgesia (IV-PCA). In addition;
 intrathecal opioids, one catheter epidural with intermittent dosing bolus of morphine or
 continuous infusion (either opioids or local anaesthetics or both), double epidural catheter
 with continuous infusion and intravenous ketamine infusion were preferred other postoperative
 pain management models.

 Epidural analgesia is accepted procedure with the efficacy and safety profile for
 postoperative pain management in major orthopedic surgery including scoliosis surgery.
 Epidural analgesia techniques commonly have been used in continuous infusion of local
 anesthetics with or without opioid. It was emphasized that there was not adequate data in the
 literature to provide argument concerning the use of epidural opioids after spinal surgery.
 The objective of this study was to compare the effects and side effects patient- controlled
 intermittent bolus epidural analgesia (PCIEA) and patient- controlled continuous epidural
 analgesia (PCCEA) with morphine for postoperative pain control in adolescent idiopathic
 scoliosis after posterior spinal fusion.

 Methods This prospective randomized controlled double-blinded study was conducted 47 patient
 between 8-18 years, American Society of Anesthesia Classification (ASA) I-II, with idiopathic
 scoliosis, scheduled for elective posterior spinal fusion.

 Patients with a history of allergy to the drugs used in the study protocol, drug abused ,
 preoperative neurologic deficit, inability to use a visual analogue scale, pulmonary, cardiac
 and neuropsychiatric disorders were excluded. Exclusion criteria during the study were
 accidental perforation of dura, faulty epidural catheter placement, postoperative neurologic
 deficit or uncontrollable nausea, vomiting and pruritus.

 Patients were divided into two groups using the envelope drawing method. Patients who
 received epidural morphine with PCIEA represented Group 1, epidural morphine with PCCEA
 represented Group 2. The anesthetist who collected data and the patients were blinded.

 All operations were performed by the same surgical team. The posterior instrumentation with
 pedicle screws was applied to thoracic and lumbar spine. Epidural catheter was inserted by
 surgeon under direct visualization at the midpoint of the incision and advanced 5-6 cm
 cephalad to thoracic 4-5 before surgical closure. Intubated patients was taken to in the
 reanimation intensive care unit after operation, IV acetaminophen 15 mg / kg was started
 before extubation and repeated every 6 hours.

 After extubation and a neurological examination, patients in the PCİEA group received
 morphine 50 µg/kg in 10 mL bolus, lockout time 1 hour, no infusion. In Group 2, PCECA
 infusion the following initial setting loading morphine 0.02mg/kg in 8mL, was maintained 0.01
 mg/kg continuous infusion 4mL, 0.05 mg/kg 2mL bolus dose. 30 minute lock-out interval. 4 hour
 limit was 4 mg/kg.

 Pain score, morphine usage, postoperative nausea and vomiting, pruritus, rate their
 satisfaction ,sedation scores and motor block were assessed by researchers who were blinded
 to the study groups at postoperatively 2., 4., 6., 8., 12., 18., ve 24.hour, in all patients.

 The data were given as median with min and max values Statistical analysis was performed
 using IBM SPSS statistics software 22.0. the groups were compared using Yates' corrected
 chi-square test and Mann-Whitney U test. Statistical significance was defined as P< 0.05
Inclusion Criteria:Clinical diagnosis of idiopathic scoliosis

 -  scheduled for elective posterior spinal fusion

 -  American Society of Anesthesia Classification (ASA) I-II

 Exclusion Criteria:

 -  with a history of allergy to the drugs used in the study protocol,

 -  drug abused ,

 -  preoperative neurologic deficit,

 -  inability to use a visual analogue scale, pulmonary,

 -  cardiac and neuropsychiatric disorders were excluded.

 Exclusion criteria during the study:

 -  accidental perforation of dura,

 -  faulty epidural catheter placement, postoperative neurologic deficit

 -  uncontrollable nausea, vomiting and pruritus.