ABSTRACT
STUDY DESIGN: Epidural infusion was compared with standard patient-controlled analgesia (PCA) in 50 patients after surgical correction of adolescent idiopathic scoliosis with respect to certain postoperative parameters. OBJECTIVES: To compare postoperative parameters after posterior spinal instrumentation and fusion (PSIF) and to determine whether epidural infusion prolongs hospital stay or increases the risk of complications. SUMMARY OF BACKGROUND DATA: Patient-controlled analgesia and epidural infusion are both safe and effective in controlling postoperative pain after PSIF. One criticism of epidural infusion has been longer hospital stays. No study was found in the literature in which PCA was compared with epidural infusion. METHODS: The records of 50 consecutive patients who had undergone PSIF were reviewed. The epidural group consisted of 30 patients and the PCA group 20. Age, weight, degree of curve, and levels fused were evenly matched. Postoperative parameters including the day that each patient tolerated a full diet, day of independent ambulation, length of hospital stay, and pain control were compared. RESULTS: Pain control was comparable in each group. The epidural group tolerated a full diet earlier and on average were discharged 0.5 days sooner than the PCA group. Both differences are statistically significant. No significant complications were reported in either group. CONCLUSIONS: Epidural infusion of opioids with bupivacaine is safe and effective for controlling postoperative pain after PSIF without an increased complication rate when compared with PCA. In the current study, patients tolerated a full diet and were discharged from the hospital an average of 0.5 days earlier than PCA-treated patients.
Subject(s)
Analgesia, Epidural , Analgesia, Patient-Controlled , Analgesics, Opioid/administration & dosage , Infusion Pumps , Pain, Postoperative/drug therapy , Scoliosis/surgery , Adolescent , Analgesia, Epidural/methods , Analgesia, Patient-Controlled/methods , Anesthetics, Local/therapeutic use , Bupivacaine/therapeutic use , Drug Combinations , Female , Humans , Male , Retrospective Studies , Self Administration , Spinal FusionABSTRACT
Diagnostic ultrasound has an important place to play in aiding the obstetrician who has an abortion practice. It is most useful in accurately dating the time of conception. Based on sonographic dating, an abortion may be possible in patients with multiple pregnancy or in whom there is a mass in addition to pregnancy. The performance of a saline or urea abortion is made easier since the precise site of the uterus can be mapped out. Once an abortion has commenced, the presence or absence of retained products can be easily verified by ultrasound.
PIP: Diagnostic sonography has been helpful in aiding the obstetrician who performs abortion and in deciding which technique will be appropriate in patients with a borderline gestational age. It is useful in accurately dating the time of conception. With the aid of sonographic dating, an abortion may be possible in patients with multiple pregnancy or in whom there is an additional mass. A saline or urea abortion can be facilitated since the precise site of the uterus can be visualized. In addition, the presence of absence of retained pro ducts following an abortion can be easily detected by ultrasound.