Sarwahi Vishal, Morledge Alexander, Cohen Anabelle, Eigo Katherine, Rahman Effat, Sarwahi Viraaj, Liao Benita, Kars Michelle, Lo Yungtai, DiMauro Jon-Paul, Amaral Terry
Cohen Children's Medical Center, Department of Pediatric Orthopaedics, New Hyde Park, NY.
Cohen Children's Medical Center, Department of Anesthesiology, Queens, NY.
Spine (Phila Pa 1976). 2025 Sep 11. doi: 10.1097/BRS.0000000000005499.
Retrospective Cohort Study.
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.
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.
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.
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).
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.
回顾性队列研究。
本研究旨在调查采用我院利用小剂量鞘内吗啡（ITM）的快速康复方案（RRP）进行后路脊柱融合术（PSF）的青少年特发性脊柱侧凸（AIS）患者的治疗结果。
减少青少年人群的阿片类药物暴露非常必要。由于具有持久的镇痛特性，小剂量鞘内吗啡（ITM）在产科手术及其他亚专业中已变得很常见。我们假设这种ITM-RRP方案将减少该大样本中的阿片类药物消耗。
纳入2015年至2023年间接受后路脊柱融合术（PSF）的脊柱畸形儿科患者的回顾性队列研究。2018年RRP实施前的患者属于PCA组（2015 - 2017年），RRP实施后接受该手术的患者（2018 - 2023年）属于ITM-RRP组。测量的结果包括术中、术后及总的阿片类药物消耗量，以及住院时间、视觉模拟评分法（VAS）疼痛评分、呕吐率和90天并发症发生率。
与PCA组患者相比，ITM-RRP组患者活动时的VAS疼痛评分更低（P < 0.001），更早下床（P < 0.001），更早出院（P < 0.001），呕吐率更低（P < 0.001），首次排便更早（P < 0.001）。ITM-RRP组患者术中（P < 0.001）、术后（P < 0.001）及总体（P < 0.001）的阿片类药物消耗量显著更少。ITM-RRP组和PCA组的90天并发症发生率（P = 0.28）及呼吸并发症发生率（P = 0.94）相似。
采用小剂量吗啡的ITM-RRP方案在PSF术后疼痛管理中有效。这很有价值，因为它不仅能减少青少年阿片类药物暴露的剂量，还能缩短暴露时间，降低未来阿片类药物依赖的可能性。
