The Analgesic Efficacy of A Novel Thoracolumbar Dorsal Rami Nerve Block Using Multiorifice Pain Catheters for Scoliosis Surgery, Case Report

Scoliosis is the most common spinal deformity in adolescent children and approximately 29,000 of the 4 million total cases are surgically corrected every year in the United states. Post-operative pain management after posterior spinal fusion for adolescent idiopathic scoliosis can be challenging and is usually multi modal including IV and oral opioids, intrathecal morphine, continuous epidural infusions and even subcutaneous local anesthetic infusions, all of which have their respected side effects including respiratory depression, drowsiness, hypotension and sensorimotor dysfunction. In this case report we demonstrate a novel approach to post-operative pain management via placement of multi-orifice infusion catheters lateral to the surgically placed Harrington rods that lie directly in the vicinity of the thoracic dorsal rami nerves. In this case report we demonstrate that continuous infusion of local anesthetic to this region significantly improved a patient’s pain and led to a decrease in PCA usage, all the while bypassing the potential untoward side effects of epidural infusions. The benefits of placing these catheters intraoperatively directly in the surgical site helps avoid potential pitfalls like epidural hematomas, post dural puncture headaches and high spinals, all the while providing analgesia to the vertebral column and thoracic musculature. Further investigation into the efficacy of this new technique is required but could drastically improve post-operative pain after scoliosis surgery.