Abstract
Introduction: The Queensland Children’s Hospital (QCH) in Brisbane, Australia offers continuous epidural analgesia as standard postoperative care for adolescent idiopathic scoliosis following posterior spinal instrumented fusion. Intravenous patient-controlled analgesia, is a well-established alternative for managing postoperative pain. Both modalities are associated with side effects. Epidurals are linked to transient neurological changes, while patient controlled analgesia is associated with opioid induced complications. To compare continuous epidural analgesia to patient controlled analgesia, data from Queensland Children’s Hospital and the Royal Children’s Hospital (RCH) (where patient controlled analgesia is standard for postoperative analgesia), was analyzed. The primary objective was to assess safety and side-effects of both methods by assessing objective postoperative outcomes.
Methods: A retrospective chart review was conducted at Queensland Children’s Hospital from 06/01/2020 to 19/12/2022 and at Royal Children’s Hospital from 07/01/2020 to 13/12/2022. The study included 203 patients, with 120 patients from Royal Children’s Hospital and 83 from Queensland Children’s Hospital. Mean ages were 14.64 +/- 1.54 and 14.92 +/- 1.71 respectively (P=0.28). Mean cobb scores were 70.55 +/- 17.83 and 66.70 +/- 10.59 respectively (P=0.06). Data analysis involved student's t-test and Chi-squared analysis using SPSS software.
Results: Patient demographics were comparable, however Queensland Children’s Hospital patients had more levels fused (P<0.01). Queensland Children’s Hospital patients experienced lower rates of sedation and discharge without a bowel motion (P<0.01). Temporary neurological complications were exclusive to QCH patients (26 cases), however all cases resolved without further complications. Rates of respiratory depression, postoperative nausea and vomiting, readmissions and deep surgical infections were similar (P>0.05). At RCH, 51.67% of patients mobilized with physiotherapy assistance of POD1, compared to 54.22% at QCH. Mean discharge time for Royal Children’s Hospital and Queensland Children’s Hospital was 3.45+/-1.15 and 5.36+/-1.69 days respectively (P<0.01). Both centres had 6 unplanned readmissions (P=0.49).
Conclusion: Both continuous epidural and patient-controlled analgesia are safe and effective following posterior spinal fusion for adolescent idiopathic scoliosis, though they differ in complication profiles. Epidurals are linked to transient neurological effects, while PCA is associated with opioid-related sedation and respiratory depression. Differences in recovery outcomes, particularly diet resumption and discharge, may reflect the impact of accelerated discharge pathways on optimizing patient recovery.