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Comparison of high- and low-dose intrathecal morphine for spinal fusion in children

S Eschertzhuber1, M Hohlrieder, C Keller

  • 1Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. stephan.eschertzhuber@i-med.ac.at

British Journal of Anaesthesia
|February 29, 2008
PubMed

Insights

Low-dose intrathecal opioids (ITO) significantly reduce blood loss and pain in pediatric scoliosis surgery. A low-dose regimen is as effective as a high-dose regimen, with comparable side-effect rates.

Area of Science:

  • Anesthesiology
  • Pediatric Surgery
  • Pharmacology

Background:

  • Scoliosis surgery in children often involves significant blood loss and postoperative pain.
  • Intrathecal opioids (ITO) are used to manage pain, but optimal dosing requires investigation.
  • Assessing the blood-sparing effect, analgesia quality, and side-effects of low-dose versus high-dose ITO is crucial.

Purpose of the Study:

  • To compare the blood-sparing effect of low-dose intrathecal opioids (LITO) versus high-dose intrathecal opioids (HITO) in pediatric scoliosis surgery.
  • To evaluate the quality of postoperative analgesia and opioid requirements with LITO and HITO.
  • To determine the incidence of side-effects associated with different intrathecal opioid regimens.

Main Methods:

  • A prospective study involving 46 children undergoing scoliosis surgery.
  • Randomization into three groups: LITO (morphine 5 mcg/kg + sufentanil 1 mcg/kg), HITO (morphine 15 mcg/kg + sufentanil 1 mcg/kg), or control (no intrathecal opioid).
  • Postoperative analgesia supplemented with intravenous opioids; data collected on blood loss, pain scores, opioid consumption, and side-effects for 3 days.

Main Results:

  • Intrathecal opioids significantly reduced intraoperative blood loss in both LITO and HITO groups compared to controls (41.4 and 37.5 ml/kg vs. 76.9 ml/kg, P<0.001).
  • Mean pain scores on the day of surgery were lower in LITO and HITO groups (2.2 and 2.1) versus controls (4.1, P<0.03).
  • Opioid consumption was significantly decreased in LITO and HITO groups (304.3 and 224.1 mcg/kg) compared to controls (667.7 mcg/kg, P<0.002); side-effects were similar across all groups.

Conclusions:

  • Intrathecal administration of opioids effectively reduces blood loss and postoperative opioid demand in pediatric scoliosis surgery.
  • A low-dose regimen of intrathecal opioids provides significant benefits, with no additional efficacy gained from a high-dose regimen.
  • Side-effect profiles were comparable between intrathecal opioid groups and the control group, suggesting a favorable safety profile.
Abstract

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