Maier Jacob C, Meyer Andrew J, Hord Catherine, Steiner Richard P, Bhalla Tarun, Ritzman Todd F, Floccari Lorena V
Department of Orthopedic Surgery, Summa Health System.
Department of Anesthesia, Akron Children's Hospital.
Spine (Phila Pa 1976). 2025 Dec 1;50(23):1624-1629. doi: 10.1097/BRS.0000000000005398. Epub 2025 Jul 11.
Retrospective cohort study.
The purpose of this study is to compare outcomes of intrathecal morphine (ITM) administered preemptively versus intraoperatively, either before or after correction, in adolescent idiopathic scoliosis (AIS) patients.
As a component of a multimodal pain regimen, ITM can reduce postoperative pain in pediatric patients undergoing spinal fusion, but the optimal timing of administration is unclear.
Consecutive AIS patients who underwent posterior spinal fusion at a single institution were retrospectively reviewed. Patients were either given ITM before incision, during exposure, or after deformity correction. Opiate consumption was measured and converted to milligram of morphine equivalents (MME).
A total of 146 patients were included (85 preoperative, 17 intraoperative before correction, and 45 intraoperative after correction). There were no statistically significant differences among groups in patient demographics or curve characteristics ( P > 0.05). ITM dosages were similar among groups, as were other intraoperative anesthetic infusions, including vasopressors and total intraoperative MME. There were no significant differences in operative time, blood loss, transfusion rate, or postoperative opioid consumption, including daily and total hospitalization MME (69.7 vs . 60.7 vs . 75.3, P = 0.365). Hospital length of stay (2.9 vs . 2.8 vs . 2.9 d, P = 0.749), potential side effects (hypotension, pruritis, and nausea/vomiting), 30-day emergency department visits, and readmissions were all similar among groups (all P > 0.05).
For AIS patients undergoing posterior spinal fusion, the timing of intrathecal morphine administration has no significant impact on perioperative pain control, functional recovery, or early outcomes. No difference in MME administration, length of stay, potential side effects (hypotension, pruritis, and nausea/vomiting), or early outcomes was observed between groups. Thus, ITM can be given either preoperatively or intraoperatively at the discretion of the surgical and anesthetic teams.
回顾性队列研究。
本研究旨在比较青少年特发性脊柱侧凸（AIS）患者术前、术中（矫正前或矫正后）鞘内注射吗啡（ITM）的效果。
作为多模式镇痛方案的一部分，ITM可减轻接受脊柱融合术的儿科患者的术后疼痛，但最佳给药时间尚不清楚。
回顾性分析在单一机构接受后路脊柱融合术的连续AIS患者。患者在切口前、暴露期间或畸形矫正后接受ITM治疗。测量阿片类药物消耗量并换算成吗啡当量毫克数（MME）。
共纳入146例患者（85例术前、17例矫正前术中、45例矫正后术中）。各组患者的人口统计学特征或侧弯特征无统计学显著差异（P>0.05）。各组间ITM剂量相似，其他术中麻醉输注量，包括血管加压药和术中总MME也相似。手术时间、失血量、输血率或术后阿片类药物消耗量无显著差异，包括每日和住院总MME（69.7 vs. 60.7 vs. 75.3，P = 0.365）。住院时间（2.9 vs. 2.8 vs. 2.9天，P = 0.749）、潜在副作用（低血压、瘙痒和恶心/呕吐）、30天内急诊就诊次数和再入院率在各组间均相似（均P>0.05）。
对于接受后路脊柱融合术的AIS患者，鞘内注射吗啡的时间对围手术期疼痛控制、功能恢复或早期结局无显著影响。各组间在MME给药量、住院时间、潜在副作用（低血压、瘙痒和恶心/呕吐）或早期结局方面未观察到差异。因此，手术和麻醉团队可根据情况在术前或术中给予ITM。
