Klatt Joshua W B, Mickelson Jennie, Hung Man, Durcan Simon, Miller Chris, Smith John T
*Department of Orthopaedic Surgery, University of Utah School of Medicine, Primary Children's Medical Center, Salt Lake City, UT †Department of Orthopaedic Surgery, University of Utah School of Medicine, University Orthopaedic Center, Salt Lake City, UT; and ‡Department of Anesthesia, Primary Children's Medical Center, Salt Lake City, UT.
Spine (Phila Pa 1976). 2013 Sep 1;38(19):1626-31. doi: 10.1097/BRS.0b013e31829cab0b.
Randomized prospective trial.
To compare the efficacy of intravenous analgesia with single and dual continuous epidural analgesia (CEA) in patients with adolescent idiopathic scoliosis (AIS) undergoing posterior spinal fusion and instrumentation (PSIF).
Pain management after posterior spinal fusion (PSF) for patients with AIS is challenging. Although intravenous patient-controlled analgesia (PCA) is used most commonly, CEA has been found to be safe and effective. Recently, the use of 2 epidural catheters has been thought to be more effective than a single catheter, although the efficacy of using 2 catheters has not been directly compared with a single catheter.
Sixty-six patients with AIS were randomized into 3 groups prior to PSF; PCA, single CEA, and double CEA. Postoperative pain scores as well as side effects, complications, and use of breakthrough medication were collected. Recovery times were also recorded, including hospitalization, times to first bowel movement, and days to walk and climb stairs. Four patients were withdrawn due to the inability to maintain the pain management protocol.
Pain intensity was most effectively controlled with a double CEA when compared with PCA (P < 0.05) and a single CEA (P < 0.05). Pain control was equivalent in both the PCA and single CEA groups (P = 0.21). The pain control method with the fewest side effects trended toward the single CEA, with an average of 2.55 side effects per patient. The majority of the side effects included pruritis, constipation, and nausea. Late onset neurological events were absent in all patients.
These data document that the double CEA most effectively controls postoperative pain after surgery for AIS. The single CEA trended toward having the fewest side effects when compared with the other techniques. On the basis these findings, we now routinely use the double CEA technique for all patients having surgery for AIS.
随机前瞻性试验。
比较静脉镇痛与单根和双根连续硬膜外镇痛（CEA）在接受后路脊柱融合内固定术（PSIF）的青少年特发性脊柱侧凸（AIS）患者中的疗效。
AIS患者后路脊柱融合术（PSF）后的疼痛管理具有挑战性。虽然静脉自控镇痛（PCA）是最常用的方法，但已发现CEA是安全有效的。最近，人们认为使用2根硬膜外导管比单根导管更有效，尽管使用2根导管的疗效尚未与单根导管直接比较。
66例AIS患者在PSF术前被随机分为3组：PCA组、单根CEA组和双根CEA组。收集术后疼痛评分以及副作用、并发症和急救药物的使用情况。还记录了恢复时间，包括住院时间、首次排便时间、行走和爬楼梯的天数。4例患者因无法维持疼痛管理方案而退出。
与PCA组（P < 0.05）和单根CEA组（P < 0.05）相比，双根CEA对疼痛强度的控制最为有效。PCA组和单根CEA组的疼痛控制效果相当（P = 0.21）。副作用最少的疼痛控制方法倾向于单根CEA组，平均每位患者有2.55种副作用。大多数副作用包括瘙痒、便秘和恶心。所有患者均未出现迟发性神经事件。
这些数据表明，双根CEA能最有效地控制AIS手术后的术后疼痛。与其他技术相比，单根CEA的副作用倾向于最少。基于这些发现，我们现在对所有接受AIS手术的患者常规使用双根CEA技术。
