A dual epidural catheter technique to provide analgesia following posterior spinal fusion for scoliosis in children and adolescents

Background: The authors report their experience with the use of a dual epidural catheter technique in controlling pain following long posterior spinal fusion and instrumentation for scoliosis in children and adolescents. Methods: Following completion of the surgical procedure and prior to wound closure, the upper catheter was inserted with the tip directed cephalad to T1–4 while the tip of the lower catheter was positioned at the L1–4 level. As the surgical wound was being closed, the catheters were dosed with fentanyl and hydromorphone followed by a continuous infusion of ropivacaine plus hydromorphone. Postoperative pain was assessed every 2–4 h using a visual analogue score or an observational behavioural score (0=no pain, 10=worst imaginable pain). There were 14 patients ranging in age from 5–17 years (12.7 ± 3.5) and in weight from 19–68 kg (44.3 ± 17.5). The epidural catheters were left in place until the fifth postoperative day. Results: The mean of the median pain score from each patient was 1.5 ± 1.6, 1.6 ± 1.5, 1.4 ± 1.3, 1.1 ± 1.1 and 0.9 ± 0.9, respectively, on postoperative days 1 through 5. The mean of the maximum pain scores was 3.5 ± 2.3 (range 0–7), 4 ± 1.6 (range 2–6), 3.1 ± 1.7 (range 1–6), 2.4 ± 1.5 (range 0–4) and 2.2 ± 1.4 (range 0–4), respectively, on postoperative days 1 through 5. Conclusions: No adverse effects related to epidural analgesia were noted.