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Intrathecal Morphine Following Lumbar Fusion: A Randomized, Placebo-Controlled Trial

Perry Dhaliwal1, Daniel Yavin2,3, Tara Whittaker2

  • 1Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.

Neurosurgery
|September 29, 2018
PubMed
Abstract

Insights

Intrathecal morphine safely reduces postoperative pain after lumbar fusion surgery. This method also lowers opioid needs without increasing respiratory risks, though benefits diminish after 48 hours.

Area of Science:

  • Neurosurgery
  • Anesthesiology
  • Orthopedic Surgery

Background:

  • Intrathecal morphine offers potential for faster recovery and easier administration in spine surgery.
  • However, its use in lumbar spine surgery remains infrequent.
  • This study investigates its application in lumbar fusion procedures.

Purpose of the Study:

  • To evaluate the safety and efficacy of intrathecal morphine administration following lumbar fusion surgery.
  • To assess its impact on postoperative pain and opioid consumption.

Main Methods:

  • A randomized controlled trial involving 150 patients undergoing elective instrumented lumbar fusion.
  • Patients received either a single intrathecal injection of 0.2 mg morphine or a placebo (normal saline) before wound closure.
  • Primary outcome was pain (visual-analogue scale) in the first 24 hours; secondary outcomes included respiratory depression, side effects, opioid use, and hospital stay.

Main Results:

  • Intrathecal morphine significantly reduced pain at rest and with movement within the first 24 hours post-surgery.
  • No increased risk of respiratory depression was observed.
  • Postoperative opioid requirements were reduced, but hospital stay duration remained similar.
  • Early pain relief benefits were not sustained beyond 48 hours.

Conclusions:

  • A single intrathecal injection of 0.2 mg morphine is a safe and effective method for reducing postoperative pain after lumbar fusion.
  • It also decreases the need for additional opioids without compromising respiratory function.
Keywords:
Intrathecal morphineLumbar fusionPostoperative analgesiaPostoperative painRandomized controlled trialRespiratory depression

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