Journal of Pediatric Orthopaedics - 2026-03-26 - Journal Article
A Comparison of Continuous Epidural, Spinal Opioid,and Patient-Controlled Analgesia for Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Multicenter, International Database Study.
Halpern LM, Zhang DA, Kogan CJ, Ryan KA, Correll Z, Bronson W
Topics
Key Takeaway
Spinal opioid and epidural analgesia reduce total opioid consumption by more than 50% compared to PCA (1.7 and 1.9 vs. 4.1 OME/kg) after posterior spinal fusion for AIS, without improving pain scores, complication rates, or length of stay.
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Summary
This retrospective multicenter database study compared three postoperative analgesia strategies—continuous epidural, spinal opioid, and PCA—in AIS patients aged 13–19 undergoing posterior spinal fusion. Spinal opioid (1.7 OME/kg) and epidural (1.9 OME/kg) groups consumed significantly less opioid than PCA (4.1 OME/kg, P<0.002). Despite this difference, mean daily pain scores, complication rates, and length of stay were not clinically different across groups.
Key Limitation
The retrospective, non-randomized design cannot exclude confounding by institutional protocol, surgeon preference, or patient selection when assigning analgesia modality, limiting causal inference.
Original Abstract
BACKGROUND
There is conflicting evidence for the optimal method of analgesia following posterior spinal fusion for adolescent idiopathic scoliosis. The primary objective of this study is to test which method of postoperative analgesia (continuous epidural, spinal opioids, or patient-controlled analgesia) is associated with reduced opioid requirements, pain scores, complications, and length of stay.
METHODS
This is a retrospective, multicenter study of the Shriners Children's International Pediatric Spine Database. Patients ages 13 to 19 years who had posterior spinal fusion with segmental spinal instrumentation for adolescent idiopathic scoliosis between January 01, 2011, and November 5, 2021, were eligible. Patients were divided into 3 cohorts based on the primary method of postoperative analgesia: continuous epidural (EPI), spinal opioid (SPI), or patient-controlled analgesia (PCA). We compared total parenteral and oral opioid usage, verbal numeric pain scores, complications, and the length of stay.
RESULTS
A total of 2371 patients from 13 hospitals were included in the study. Total parenteral and oral opioid usage in the spinal and epidural groups was significantly lower compared with the patient-controlled analgesia group [OME/kg: SPI 1.7 (95% CI: 1.1-2.5) vs. EPI 1.9 (95% CI: 1.1-3.2) vs. PCA 4.1 (95% CI: 3.4-4.8): P<0.002]. There were no clinically significant differences in mean daily pain scores, complications, or length of stay.
CONCLUSIONS
Spinal opioid and continuous epidural analgesia decrease parenteral and oral opioid requirements compared with patient-controlled analgesia. The increased opioid usage in the patient-controlled analgesia group does not lead to clinically significant differences in pain scores, complications or length of stay. We conclude that all 3 methods of analgesia provide safe and effective pain relief. This study reinforces the need for collaboration between pediatric orthopaedic surgeons and anesthesiologists to effectively manage postoperative pain following posterior spinal fusion for adolescent idiopathic scoliosis.
LEVEL OF EVIDENCE
Level III-therapeutic study.