Cohen Children's Medical Center, Department of Orthopedics, New Hyde Park, NY.
Cohen Children's Medical Center, Department of Anesthesiology, Queens, NY.
Spine (Phila Pa 1976). 2021 Nov 1;46(21):1448-1454. doi: 10.1097/BRS.0000000000004062.
Retrospective review.
The objective of this study was to report on one institution's use of single bolus micro-dose intrathecal morphine as part of a rapid recovery pathway during posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) and its comparison to patients whose pain was controlled with patient-controlled analgesia (PCA).
Narcotic substance addiction has risen across all patient populations, including pediatrics. Narcotics have been historically used in complex spine surgeries as a measure of pain control, predominantly provided as PCA and additional take-home medication.
AIS patients undergoing PSF from 2015 to 2019 were reviewed. In 2018, we instituted a standardized rapid recovery pathway for scoliosis patients undergoing PSF utilizing micro-dose intrathecal morphine (ITM-RRP). Before this, traditional protocol with PCA was used for postoperative management. Perioperative data, morphine consumption and prescription refill requests were compared.
There were 373 AIS patients total in this study, of which 250 patients were in the PCA group and 123 in the ITM-RRP Group. Preoperative Cobb angles (P = 0.195), as well as levels fused (P = 0.481) and body mass index (P = 0.075) were similar. 69.4% of ITM-RRP patients had a length of stay ≤3 days, significantly >11.6% of PCA patients (P < 0.001). ITM-RRP patients began ambulating significantly earlier with 84.6% patients out of bed by postoperative day 1 versus 8% PCA patients (P < 0.001). Additionally, ITM-RRP patients had significantly lower VAS pain scores with activity and earlier initial bowel movements (P < 0.001).Postoperative emesis was similar (P = 0.11). No patients had pruritus, respiratory depression, or required supplemental oxygenation.
This is the first study to show that a rapid recovery protocol utilizing single micro-dose ITM with oral analgesics have adequate recovery, significantly better postoperative pain control and superior perioperative outcomes to traditional protocols using PCA in the AIS population following PSF.Level of Evidence: 3.
回顾性研究。
本研究的目的是报告一家机构在青少年特发性脊柱侧凸（AIS）后路脊柱融合术（PSF）中使用单次推注小剂量鞘内吗啡作为快速康复途径的一部分，并将其与使用患者自控镇痛（PCA）控制疼痛的患者进行比较。
阿片类药物成瘾在包括儿科在内的所有患者群体中都有所上升。在历史上，阿片类药物一直被用于复杂的脊柱手术，作为控制疼痛的一种手段，主要通过 PCA 和额外的带药回家来提供。
回顾了 2015 年至 2019 年接受 PSF 的 AIS 患者。2018 年，我们为接受 PSF 的脊柱侧凸患者制定了一项标准化的快速康复途径，使用鞘内小剂量吗啡（ITM-RRP）。在此之前，传统的 PCA 方案用于术后管理。比较围手术期数据、吗啡消耗和处方补充请求。
本研究共有 373 例 AIS 患者，其中 250 例患者在 PCA 组，123 例患者在 ITM-RRP 组。术前 Cobb 角（P=0.195）、融合节段（P=0.481）和体重指数（P=0.075）相似。69.4%的 ITM-RRP 患者的住院时间≤3 天，明显高于 11.6%的 PCA 患者（P<0.001）。ITM-RRP 患者更早开始活动，84.6%的患者术后第 1 天离床，而 PCA 患者为 8%（P<0.001）。此外，ITM-RRP 患者的活动时 VAS 疼痛评分和首次肠蠕动更早（P<0.001）。术后呕吐相似（P=0.11）。没有患者出现瘙痒、呼吸抑制或需要补充吸氧。
这是第一项研究表明，在 AIS 人群中，与传统的 PCA 方案相比，使用单次小剂量 ITM 联合口服镇痛药的快速康复方案具有足够的恢复能力，显著更好的术后疼痛控制和更好的围手术期结果。
3 级。
