Role of epidural analgesia in the perioperative pain management of scoliosis surgery in adolescents: a narrative review

Abstract

This review attempts to provide a comprehensive evaluation of the scientific literature on epidural analgesia in comparison with other analgesia regimen for postoperative pain management in paediatric and adolescent posterior thoraco-lumbar spine surgery. Epidural anaesthesia is said to be associated with better pain control compared to traditional intravenous analgesia alone, as it targets pain at the site of surgery, potentially reducing the need for systemic opioids and their associated side effects. However, its use in children remains bringing controversy and presents unique challenges. A comprehensive literature search was conducted through the databases of PubMed, Cochrane Library and Web of science. We focused on studies and trials that examined the efficacy and safety of epidural analgesia compared to other analgesia regimens in adolescents and children. Epidural analgesia has been shown to provide effective postoperative pain relief in patients undergoing thoraco- lumbar spine surgery, offering benefits such as reduced opioid use, improved patient satisfaction and a faster return of gastrointestinal function. Complications related to epidural analgesia, such as catheter related complications, adverse events and severe complications were reported but are very rare. Despite these risks, epidural analgesia was generally associated with better outcomes compared to intravenous analgesia, with improved pain control and beginning to earn its place in enhanced recovery protocols. The evidence quality was low and there were significant variations in the methods and pain regimens used across studies. We can conclude that epidural analgesia is a valuable technique for managing postoperative pain in paediatric thoraco- lumbar spine surgery. While it offers certain advantages over intravenous analgesia, its implementation must be carefully managed to avoid potential complications. This review highlights the need for further research to refine the optimal use and implementation of epidural anaesthesia protocols in paediatric and adolescent populations for posterior spinal fusions (PSF).