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PCA-pump for analgesia following pediatric scoliosis surgery: bolus administration with/without basal infusion
Cengiz Isik1, Abdullah Demirhan2, Tacettin Ayanoglu1
1Department of Orthopaedics and Traumatology, Bolu Abant Izzet Baysal University, Bolu, Turkey.
Insights
For pediatric scoliosis surgery, patient-controlled analgesia (PCA) with bolus only is as effective as PCA with basal infusion for pain control. Bolus PCA reduces morphine consumption and side effects like vomiting.
Area of Science:
- Anesthesiology
- Orthopedic Surgery
- Pain Management
Background:
- Postoperative pain management is critical in pediatric scoliosis surgery.
- Opioid-based patient-controlled analgesia (PCA) is commonly used.
- Different PCA delivery methods may impact efficacy and side effects.
Purpose of the Study:
- To compare bolus PCA with and without basal infusion for postoperative pain control.
- To evaluate the side effect profiles of these two PCA methods.
- To determine the optimal PCA strategy for pediatric scoliosis surgery patients.
Main Methods:
- A randomized controlled trial involving 38 pediatric patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis.
- Patients were divided into two groups: bolus PCA only (Group 1) and bolus PCA with basal infusion (Group 2).
- Morphine consumption, pain scores (NRS, Wong-Baker), vital signs, sedation levels (Ramsay), and side effects were recorded.
Main Results:
- Morphine consumption was significantly lower in the bolus PCA group (Group 1) at 12-24 and 0-48 hours (p=0.001).
- No significant differences were found in pain scores (NRS, Wong-Baker) or sedation levels (Ramsay) between the groups.
- Vomiting occurred more frequently and for longer durations in the group receiving basal infusion (Group 2) (p<0.05).
Conclusions:
- Both bolus PCA and PCA with basal infusion are equally effective for postoperative pain management after posterior spinal fusion.
- PCA with basal infusion leads to increased opioid consumption and more systemic side effects, particularly vomiting.
- The study recommends encouraging the use of bolus PCA alone in pediatric scoliosis surgery.
Objectives:
The aim of this study is to compare the use of two different opioid delivery systems (bolus PCA with/without basal infusion) to control postoperative pain and evaluate the side effect profile in pediatric patients undergoing scoliosis surgery.
Patients And Methods:
38 patients who underwent posterior spinal fusion for adolescent idiopathic scoliosis were included in the study. Patients were randomly divided into 2 groups by the computer. Patients who received only bolus PCA were named Group 1, and patients who received bolus PCA with basal infusion were named Group 2.Morphine consumption, postoperative pain assessmentduring rest, movement and coughing with numeric rating scale (NRS) and the Wong -Baker pain scale, heart rate and average blood pressure, sedation levels withRamsey sedation scale and side effects such as nausea, vomiting, itching, desaturation, and urinary retention were recorded.
Results:
Total mean morphine consumption (mg) was 32.7 ± 9.7 in Group 1 and 43.4 ± 9.1 in Group 2. The mean morphine consumption (mg) at 12-24 hours and 0-48 hours in Group 1 was statistically lower than Group 2 (p = 0.001). There was no significant difference between the groups in terms of median NRS scores (p = 0.55). There was no statistically significant difference in the evaluation of the groups in terms of Wong-Baker pain scale. Wong-Baker pain scale is p:0.66 at the 2nd hour, p:0.951 at the 12th hour and p:0.467 at the 24th hour.There was no statistically significant difference in Ramsay Sedation Scale evaluation between groups during each follow-up time (p > 0.05). The Ramsay Sedation Scale was p: 0.94 at the 2nd hour, p:1.0 at the 12th hour, and p:1.0 at the 24th hour. The duration of vomiting between 0-2 h, 2-24 h and 0-48 h was higher in Group 2 (p = 0.001, p = 0.024, p = 0.001).
Conclusion:
The two administration settings of morphine sulphate by PCA pump have shown to be equally effective in the treatment of postoperative pain following PSF. In addition, PCA with basal infusion administration causes more opioid consumption and more systemic side effects. Therefore, the use of only bolus PCA in pediatric scoliosis surgery should be encouraged.
Level Of Evidence:
Level II, Randomized Controlled Trial.
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