The safety and efficacy of intrathecal morphine in pediatric spinal deformity surgery: a 25-year single-center experience

• Published in: Spine deformity 2021-09, Vol.9 (5), p.1303-1313
• Main Authors: Poe-Kochert, Connie, Ina, Jason G., Thompson, George H., Hardesty, Christina K., Son-Hing, Jochen P., Rubin, Kasia, Tripi, Paul A.
• Format: Article
• Language: English
• Subjects: Case Series; Medicine; Medicine & Public Health; Orthopedics
• ISSN: 2212-134X; 2212-1358
• DOI: 10.1007/s43390-021-00320-8

Purpose Pre-incision intrathecal morphine (IM) is a popular adjunct in adolescent idiopathic spinal deformity surgery. This study represents our 25-year experience with IM in all diagnostic groups undergoing posterior spinal fusion (PSF) and segmental instrumentation (SI). Methods Our prospective Pediatric Orthopaedic Spine Database (1992–2018) identified all patients undergoing PSF and SI. We included patients 21 years of age or less, had a PSF with SSI, and received the recommended IM dose of 9–19 mcg/kg (up to 1 mg) or no IM. We assessed demographics, pain scores, duration of surgery, time to first dose of narcotics, pediatric intensive care unit (PICU) admission, length of hospital stay, and IM complications (respiratory depression, pruritus, nausea/vomiting). Results There were 984 patients who met inclusion criteria: 760 patients received IM, 224 did not (non-IM). They were divided into 5 diagnostic groups: idiopathic, neuromuscular, syndromic, and congenital scoliosis and kyphosis. The mean first post-operative opioid following IM administration was at 16.1 h in the IM group compared to 8.7 h in the non-IM group ( p  =