Safety and Efficacy of Continuous Epidural Anesthesia Following Scoliosis Surgery in Respiratory-Impaired Neuromuscular Children: A Pilot Study

Abstract Study Design Retrospective comparative study. Objective To identify the usefulness of epidural anesthesia for postoperative pain without opioid in respiratory-impaired children with neuromuscular scoliosis. Summary of Background Data Safety and adequate postoperative pain control is the most important concern in respiratory-impaired children. In general, after a massively invasive operation analgesia is performed with continuous intravenous infusion of opioid. However, the opioid side effect of respiratory depression could be critical for these patients. Methods The authors compared a group of 5 patients with continuous epidural anesthesia (Epi[+]) and a group of 5 patients without epidural anesthesia (Epi[−]). Spinal correction was performed under general anesthesia. At the end of surgery, for patients in the Epi[+] group, an epidural catheter was inserted by a surgeon. Nonsteroidal anti-inflammatory medication was prescribed regularly for postoperative pain; additional medications were permitted following the same protocol in both groups. Via the epidural catheter, 0.2% ropivacaine was continuously infused at 4 to 6ml/hour for 3 days. The researchers compared the numeric rating scale, the frequency of use of an additional painkiller, the day patients were able to leave the bed, and the duration of the hospital stay. Results The numeric rating scale in the Epi[+] group was significantly lower than in the Epi[−] group each day; the frequency of using an additional painkiller was also lower in the Epi[+] group than the Epi[−] group. In addition, the researchers could find no complications including respiratory depression related to epidural anesthesia. Conclusions Continuous epidural anesthesia could be effective and safe in children with neuromuscular scoliosis. It could control postoperative pain from scoliosis surgery without opioids, which may cause pulmonary depression. This pilot study indicates the need for further investigations to confirm the potential benefits of this method.