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Analgesic effect of low-dose intrathecal morphine after spinal fusion in children
O Gall1, J V Aubineau, J Bernière
1Service d'Anesthésie-Réanimation, Centre Hospitalier Universitaire Armand Trousseau, Paris, France. ogall.trousseau@invivo.edu
Insights
Low-dose intrathecal morphine significantly improved pain relief after pediatric scoliosis surgery. Both 2 and 5 microg/kg doses reduced pain scores and patient-controlled analgesia (PCA) morphine use compared to saline alone.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pain Management
Background:
- Scoliosis surgery in children often involves significant postoperative pain.
- Effective pain management is crucial for recovery and patient well-being.
Purpose of the Study:
- To evaluate the analgesic efficacy of low-dose intrathecal morphine in pediatric patients undergoing spinal fusion for scoliosis.
- To compare different doses of intrathecal morphine with a placebo control.
Main Methods:
- Thirty pediatric patients (9-19 years) were randomized into three groups: saline, 2 microg/kg, or 5 microg/kg intrathecal morphine.
- Postoperative pain was managed with patient-controlled analgesia (PCA) intravenous morphine.
- Patients were monitored for 24 hours in the postanesthesia care unit.
Main Results:
- Intrathecal morphine dose-dependently delayed the first PCA demand.
- Both 2 and 5 microg/kg doses significantly reduced pain scores at rest compared to saline.
- PCA morphine consumption in the first 24 hours was substantially lower in the morphine groups.
Conclusions:
- Low-dose intrathecal morphine, combined with PCA, offers superior analgesia after pediatric spinal fusion compared to PCA alone.
- The 2 and 5 microg/kg doses demonstrated similar analgesic effectiveness and side-effect profiles.
- A reduction in intraoperative bleeding was noted with the 5 microg/kg dose, but not the 2 microg/kg dose.
Background:
This study was designed to assess the postoperative analgesic effect of low-dose intrathecal morphine after scoliosis surgery in children.
Methods:
Thirty children, 9-19 yr of age, scheduled for spinal fusion, were randomly allocated into three groups to receive a single dose of 0 (saline injection), 2, or 5 microg/kg intrathecal morphine. After surgery, a patient-controlled analgesia device (PCA) provided free access to additional intravenous morphine. Children were monitored for 24 h in the postanesthesia care unit.
Results:
The three groups were similar for age, weight, duration of surgery, and time to extubation. The time to first PCA demand was dose-dependently delayed by intrathecal morphine. The first 24 h of PCA morphine consumption was 49 +/- 17, 19 +/- 10, and 12 +/- 12 mg (mean +/- SD) in the saline, 2 microg/kg morphine, and 5 microg/kg morphine groups, respectively. Pain scores at rest were significantly lower over the whole study period after 2 and 5 microg/kg intrathecal morphine than after saline, but there was no difference between intrathecal doses. Pain scores while coughing and the incidence of side effects were similar in the three groups.
Conclusions:
These data demonstrate that low-dose intrathecal morphine supplemented by PCA morphine provides better analgesia than PCA morphine alone after spinal fusion in children. The doses of 2 and 5 microg/kg seem to have similar effectiveness and side-effect profiles, whereas a reduction of intraoperative bleeding was observed in patients who received 5 microg/kg but not 2 microg/kg intrathecal morphine.
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