Thoracic epidural-general analgesia in scoliosis surgery

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 μg/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. © 2010 Elsevier Inc. All rights reserved.