Sanford Orthopedics & Sports Medicine, Sanford Health, Sioux Falls, South Dakota, USA.
Mayo Clinic, Rochester, Minnesota, USA.
Iowa Orthop J. 2022 Jun;42(1):53-56.
Length of stay (LOS) in the hospital following posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS) has decreased over the past decade due to well-defined postoperative clinical pathways, earlier mobilization, and improved pain control methods. Historically, liberal use of parenteral and oral opioids for pain control caused side effects, resulting in delayed discharge. Intraoperative intrathecal morphine (ITM) has been posited to reduce the need for postoperative opioids and to expedite the discharge process. This study examines the relationship between the use of ITM with average required postoperative opioid usage and with average LOS.
This IRB-approved retrospective cohort study examined 105 patients with AIS who received PSF with instrumentation split into two cohorts. One cohort underwent PSF via standard surgical protocol (n=40) while the other cohort received intraoperative ITM with the standard surgical protocol (n=65). Power analysis demonstrated a study power of 0.8. LOS and total postoperative opioid analgesic medication (morphine milligram equivalent, MME) data were collected. Age at surgery, gender, number of spinal levels fused, estimated intraoperative blood loss (EBL), preoperative Cobb angle, and any complications related to the use of ITM were also recorded. Continuous variables were analyzed with Student's t-test and categorical variables were analyzed with chi-square independent-sample tests using SAS 9.4 (α = 0.05).
Patients who were treated with ITM displayed shorter LOS (p<0.0001) and reduced postoperative analgesic requirement (p<0.0001). Patients who received ITM spent an average of 1.8 fewer midnights in the hospital and received an average of 221.2 MME less than patients who received standard protocol (57% decrease). There were no significant differences between the two groups for any other variable.
Intraoperative ITM is a simple and effective treatment for scoliosis surgeons to better control postoperative pain in patients, reduce the risk of dependency, and achieve earlier discharge from the hospital. Shortened LOS reduces the overall cost of care, benefitting patients, hospitals, and insurance companies. Based on the results of this study and several earlier studies, the authors recommended that scoliosis surgeons consider incorporating use of ITM into their standard operative protocols. .
由于术后临床路径明确、早期活动以及疼痛控制方法的改进，青少年特发性脊柱侧凸（AIS）后路脊柱融合术后（PSF）的住院时间（LOS）在过去十年中有所缩短。从历史上看，为了控制疼痛，大量使用静脉和口服阿片类药物会产生副作用，导致出院延迟。术中鞘内吗啡（ITM）被认为可以减少术后阿片类药物的需求，并加速出院过程。本研究检查了 ITM 的使用与术后平均阿片类药物使用量和平均 LOS 之间的关系。
这项经 IRB 批准的回顾性队列研究检查了 105 例接受 PSF 加器械治疗的 AIS 患者，将其分为两组。一组患者接受标准手术方案的 PSF（n=40），另一组患者在标准手术方案中接受术中 ITM（n=65）。 功效分析显示，研究效力为 0.8。收集 LOS 和术后总阿片类镇痛药（吗啡毫克当量，MME）数据。还记录了手术时的年龄、性别、融合的脊柱节段数、估计术中失血量（EBL）、术前 Cobb 角以及与 ITM 使用相关的任何并发症。连续变量采用 Student's t 检验进行分析，分类变量采用 SAS 9.4（α=0.05）的卡方独立样本检验进行分析。
接受 ITM 治疗的患者 LOS 更短（p<0.0001），术后镇痛需求减少（p<0.0001）。接受 ITM 的患者平均在医院度过的午夜减少 1.8 个，接受的 MME 平均减少 221.2，比接受标准方案的患者减少 57%。两组在任何其他变量方面均无显着差异。
术中 ITM 是脊柱侧弯外科医生控制术后疼痛、降低药物依赖风险并尽早出院的简单有效治疗方法。缩短 LOS 降低了整体护理成本，使患者、医院和保险公司受益。基于这项研究和其他几项早期研究的结果，作者建议脊柱侧弯外科医生考虑将 ITM 纳入其标准手术方案。
