Comparison of Preoperative vs Postincisional Intrathecal Morphine on Clinical Outcomes in Adolescent Idiopathic Scoliosis

Author Type(s)

Student

Document Type

Abstract

Publication Date

11-2023

DOI

10.1097/XCS.0000000000000835

Journal Title

Journal of the American College of Surgeons

Abstract

Introduction: Intrathecal morphine has become a widely used adjunct in pediatric scoliosis surgery. While optimal dosages and formulations have been described, it is unclear whether administration should be pre- or post-incision.

Methods: Patients with AIS undergoing primary instrumentation and fusion by three senior attendings between 2018 - 2021 were included. 215 patients met inclusion criteria, with 133 receiving intrathecal morphine pre-incisionally by the anesthesia team and 82 receiving intrathecal morphine by the surgeon at the time of closure. Outcomes measured include maximum pain score (POD 0 - 2), time to OOB, and LOS. Secondary outcomes included packed red blood cell (pRBC) transfusion, narcotic refills and complications observed. Kruskal-Wallis and Chi-Squared tests were used in data analysis to determine statistical significance.

Results: Max pain scores were significantly lower in the group receiving intrathecal morphine pre-incision (4.8 vs 5.8, p = 0.05). Looking at individual postoperative days, patients experienced similar pain scores at activity for POD 0 (3.6 vs 3.6, p = 0.97) and POD 1 (5.5 vs 5.9, p = 0.50). However, on POD 2, patients experienced significantly different pain scores (5.0 vs 6.3, p = 0.03). OOB and LOS did not show any significant differences between groups. Furthermore, there were no observed differences in transfusion, narcotics refilled, or total complications between groups.

Conclusion: Intrathecal morphine administered pre-incision leads to better and more predictable pain control in AIS patients undergoing instrumented PSF.

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