Microdose Intrathecal Morphine Injection in Teenagers Undergoing Scoliosis Surgery Decreases Length of Stay, Pain Scores, and Opioid Consumption.

STUDY DESIGN

Retrospective Cohort Study.

OBJECTIVE

This study aimed to investigate outcomes in Adolescent Idiopathic Scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with our institution's rapid recovery pathway (RRP) protocol that utilizes a micro-dose of ITM.

SUMMARY OF BACKGROUND DATA

Reducing opioid exposure among the adolescent population is extremely desirable. Micro-dose intrathecal morphine (ITM) has become common in labor and delivery surgery, among other sub-specialties, because of the long-lasting analgesic properties. We hypothesized that this ITM-RRP protocol will reduce opioid consumption in this large sample.

METHODS

Retrospective cohort study of pediatric patients with spinal deformity who underwent posterior spinal fusion (PSF) between the years 2015-2023 were included. Patients prior to the implementation of RRP in 2018 were in the PCA group (2015-2017) and patients who underwent the procedure after the implementation of RRP (2018-2023) were in the ITM-RRP group. Outcomes measured include intraoperative, postoperative, and total opioid consumption, as well as length of stay, VAS pain scores, rate of emesis, and 90-day complications.

RESULTS

ITM-RRP patients had lower VAS pain scores at activity ( P <0.001), were out of bed earlier ( P <0.001), were discharged earlier ( P <0.001), had lower rate of emesis ( P <0.001), and had their first stool earlier ( P <0.001) when compared to PCA patients. ITM-RRP patients consumed significantly less opioids intraoperatively ( P <0.001), postoperatively ( P <0.001), and overall ( P <0.001). ITM-RRP and PCA group had similar rates of 90-day complications ( P =0.28) and respiratory complications ( P =0.94).

CONCLUSION

ITM-RRP, which utilizes a micro-dose of morphine, is effective in managing postoperative pain after PSF. This is valuable because it allows for a reduction in not only the dosage of opioid exposure in adolescents but the duration as well, reducing the likelihood of opioid dependence in the future.