A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis

Hong, Rebecca A.; Gibbons, Kathleen; Li, Ying; Holman, Ashlee E.; Voepel‐Lewis, Terri

doi:10.1111/pan.13037

Cited by 38 publications

(35 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In most reports, morphine 5–20 μg/kg alone or in combination with sufentanil 1 μg/kg and diluted in 2–4 ml of saline was administered intrathecally by an anesthesiologist after the induction of anesthesia and before the surgical incision. The results of these studies show that intrathecal opioids (ITO) can reduce intraoperative opioid use as well as early postoperative opioid consumption and pain scores, but the analgesic effect does not last for more than 24 h [ 21 , 45 – 48 , 50 , 51 ] (Table 3 ). Therefore, this method is used in combination with IV PCA.…”

Section: Methodsmentioning

confidence: 99%

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

et al. 2018

View full text Add to dashboard Cite

Posterior spinal fusion for adolescent idiopathic scoliosis is one of the most invasive surgical procedures performed in children and adolescents. Because of the extensive surgical incision and massive tissue trauma, posterior spinal fusion causes severe postoperative pain. Intravenous patient-controlled analgesia with opioids has been the mainstay of postoperative pain management in these patients. However, the use of systemic opioids is sometimes limited by opioid-related side effects, resulting in poor analgesia. To improve pain management while reducing opioid consumption and opioid-related complications, concurrent use of analgesics and analgesic modalities with different mechanisms of action seems to be rational. The efficacy of intrathecal opioids and nonsteroidal anti-inflammatory drugs as components of multimodal analgesia in scoliosis surgery has been well established. However, there is either controversy or insufficient evidence regarding the use of other analgesic methods, such as continuous ketamine infusion, perioperative oral gabapentin, acetaminophen, continuous wound infiltration of local anesthetics, a single dose of systemic dexamethasone, and lidocaine infusion in this patient population. Moreover, appropriate combinations of analgesics have not been established. The aim of this literature review is to provide detailed information of each analgesic technique so that clinicians can make appropriate choices regarding pain management in patients with adolescent idiopathic scoliosis undergoing posterior spinal fusion.

show abstract

Section: Methodsmentioning

confidence: 99%

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

et al. 2018

View full text Add to dashboard Cite

show abstract

“…We previously showed that intrathecal morphine combined with oral analgesics provides safe and effective pain control after PSF for AIS. 10,12 When our institution initiated our intrathecal morphine for PSF for AIS protocol in 2014, anesthesiologists administered 12 µg/kg of intrathecal morphine (maximum 1000 µg). 10 Ninety percent of patients experienced postoperative nausea/vomiting and 40% of patients had pruritus.…”

Section: Discussionmentioning

confidence: 99%

“…8 Intrathecal morphine has been found to provide satisfactory pain control after PSF for AIS. [9][10][11][12][13][14][15] However, the patients in the majority of these studies also received a PCA, 9,11,13 continuous intravenous morphine infusion, 15 or continuous epidural infusion 14 for pain control postoperatively. We previously demonstrated that intrathecal morphine combined with oral analgesics provides safe and effective pain control after PSF for AIS.…”

Section: Introductionmentioning

confidence: 99%

Gabapentin and Intrathecal Morphine Combination Therapy Results in Decreased Oral Narcotic Use and More Consistent Pain Scores After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Liu

Swallow

Robbins

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Gabapentin and intravenous patient-controlled analgesia (PCA) can reduce postoperative pain scores, postoperative opioid use, and time to completing physical therapy compared to PCA alone after posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS). Gabapentin combined with intrathecal morphine has not been studied. The primary purpose of this retrospective study was to evaluate whether perioperative gabapentin and intrathecal morphine provide more effective pain control than intrathecal morphinealone after PSF for AIS. Methods: Patients aged 11 to 18 years who underwent PSF for AIS were identified. Patients who received intrathecal morphine only (ITM group) were matched by age and sex to patients who received intrathecal morphine and perioperative gabapentin (ITM+GABA group). The ITM+GABA group received gabapentin preoperatively and for up to 2 days postoperatively. Both groups received oxycodone and the same non-narcotic adjuvant medications.Results: Our final study group consisted of 50 patients (25 ITM, 25 ITM+GABA). The ITM+GABA group had significantly lower mean total oxycodone consumption during the hospitalization (0.798 vs 1.036 mg/kg, P<0.015). While the ITM group had a lower mean pain score between midnight and 8 am on POD 1 (2.4 vs 3.7, P=0.026), pain scores were significantly more consistent throughout the postoperative period in ITM+GABA group. The ITM+GABA group experienced less nausea/vomiting (52% vs 84%, P=0.032) and pruritus (44% vs 72%, P=0.045). Time to physical therapy discharge and length of hospital stay were similar.Conclusion: Addition of gabapentin resulted in reduced oral opioid consumption and more consistent postoperative pain scores after PSF for AIS. The patients who received intrathecal morphine and gabapentin also experienced a lower rate of nausea/vomiting and pruritus.Trial registration: All data was collected retrospectively from chart review, with institutional IRB approval. Trial registration not applicable.

show abstract

“…There are many studies that compared these methods with each other or with PCA alone. Some of these studies suggested that IMI + PCA and EPI + PCA were superior to PCA (4,6,8,10) . However, as this is an invasive procedure and several complications such as the higher rate of failure to insert a catheter into the epidural space (4,15) , causing postoperative leakage of dura mater fluid (4,9,15) , leading to respiratory depression (10) , and masking the postoperative neurological examination (2,12) , may occur, it is not chosen by some clinicians.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Effectiveness of Patient Controlled Analgesia and Pain Pump Versus Patient Controlled Analgesia Following Surgery for Adolescent Idiopathic Scoliosis

Yilar¹,

Ahişkalıoğlu²

2019

jtss

View full text Add to dashboard Cite

Objective: The pain control is a difficult and tedious process following a surgery for adolescent idiopathic scoliosis (AIS). Although there are many treatment methods used to relieve pain, the pain is not completely controlled yet. This study was aimed to compare the effectiveness of intravenous patient controlled analgesia (PCA) and a combination of PCA and pain pump (PP) (PP + PCA) used after surgery for AIS. Materials and Methods: In the present study, the results of patients at the age of 12 to 22 years, who had an AIS surgery between 2016 and 2019 at our clinic, were retrospectively reviewed. The patients' postoperative pain scores, need for opioids, time to walk, and discharge time were compared. Results: The results of 83 patients (Group PCA, n=34; Group PP + PCA, n=49) that met the study criteria were compared. The visual analogue scale (VAS) scores at the postoperative 6 th and 12 th hours were lower in the group PP + PCA (p<0.001), but there were no differences in pain scores at 24 th and 48 th hours between the groups (p>0.05). The time to walk for the group PP + PCA was significantly earlier than for the group PCA (2.67±0.99 vs. 3.68±0.94, p<0.0001). As for discharge time, the group PP + PCA was discharged earlier than the group PCA (8.00±2.03 vs. 10.00±4.56, p=0.045). With regard to the postoperative use of opioids, the use by the group PP + PCA was less than the group PCA at the end of both 24 th hour and 48 th hour (p<0.001). Conclusion: Following surgery for AIS, PP + PCA is a good choice for postoperative analgesia in the early postoperative period (the first 12 hours), reducing postoperative use of opioids and allowing patients to walk and to be discharged earlier.

show abstract

A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis

Cited by 38 publications

References 14 publications

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

Postoperative pain management in patients undergoing posterior spinal fusion for adolescent idiopathic scoliosis: a narrative review

Gabapentin and Intrathecal Morphine Combination Therapy Results in Decreased Oral Narcotic Use and More Consistent Pain Scores After Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Comparison of Effectiveness of Patient Controlled Analgesia and Pain Pump Versus Patient Controlled Analgesia Following Surgery for Adolescent Idiopathic Scoliosis

Contact Info

Product

Resources

About