Thoracic epidural-general analgesia in scoliosis surgery

• Published in: Journal of clinical anesthesia Vol. 22; no. 6; pp. 410 - 414
• Main Authors: Sundarathiti, Petchara, MD, Pasutharnchat, Koravee, MD, Jommaroeng, Pornpimon, BN
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.2010; Elsevier; Elsevier Limited
• Subjects: Adolescent; Aged; Analgesia, Epidural - adverse effects; Analgesia, Epidural - methods; Analgesics, Opioid - administration & dosage; Analgesics, Opioid - adverse effects; Anesthesia; Anesthesia & Perioperative Care; Anesthesia Recovery Period; Anesthesia, General - adverse effects; Anesthesia, General - methods; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Anesthetics, Local - administration & dosage; Anesthetics, Local - adverse effects; Biological and medical sciences; Bupivacaine - administration & dosage; Bupivacaine - adverse effects; Bupivacaine - analogs & derivatives; Cardiac arrhythmia; Catheters; Child; Epidural; General administration; Hospitals, University; Humans; Medical sciences; Middle Aged; Morphine - administration & dosage; Morphine - adverse effects; Mortality; Pain; Pain Medicine; Pain, Postoperative - drug therapy; Patient Satisfaction; Scoliosis; Scoliosis - surgery; Spinal cord; Surgery; Thoracic analgesia; Thoracic Vertebrae; Thoracolumbar scoliosis surgery; Ventilation; Thoracic analgesia; Epidural; Thoracolumbar scoliosis surgery; General administration; Deformation; General surgery; Spine; Diseases of the osteoarticular system; Spine disease; Extradural; Analgesia; Scoliosis; Anesthesia
• ISSN: 0952-8180; 1873-4529
• DOI: 10.1016/j.jclinane.2009.10.011

Abstract Study Objective To evaluate the efficacy of thoracic epidural analgesia (TEA) in scoliosis surgery. Design Descriptive clinical study. Setting University hospital. Patients 15 ASA physical status I, II, and III patients undergoing thoracolumbar scoliosis correction. Interventions TEA was performed at three to 5 cm cephalad to the incision, and 5 to 10 mL of 0.125% - 0.2% levobupivacaine was given initially. Then, 5 to 10 mL of levobupivacaine was infused hourly throughout the operation. General anesthesia (GA) was induced with thiopental sodium (5 mg/kg) and fentanyl (one μ g/kg) and was maintained with 0.2% sevoflurane and 50% nitrous oxide in oxygen. Intraoperative epidural morphine (two to three mg) was administered, and 0.1% levobupivacaine with morphine (0.04 to 0.08 mg/mL) was infused at two to 4 mL/hr for postoperative analgesia. Measurements Adequacy of anesthesia, postanesthetic recovery and analgesia, adverse effects, and patient satisfaction were recorded. Main Results 20% of patients underwent more than 10 levels of correction, and 53% had coexisting morbid diseases. All had adequate anesthesia. Immediately in the Postanesthesia Care Unit (PACU), 67% of patients reached an Aldrete score of 10, and 40% were fully awake and oriented. All patients were arousable to command and able to flex their hips and knees. None had intraoperative recall. 73% reported no pain in the PACU or 6 hours postoperatively. No serious adverse effects occured. 80% of patients rated their satisfaction as “good”. Conclusions Preincisional application of TEA with light GA may be used effectively in thoracolumbar scoliosis surgery.