For adolescents with scoliosis undergoing major spinal fusion surgery, a combination of 2 drugs reduces the amount of postoperative opioid use and side effects, according to a study published in the Journal of Orthopaedic Surgery and Research.
Adolescents who received intrathecal morphine and oral gabapentin required fewer oral narcotics after surgery, but average pain scores were more stable and patients experienced fewer side effects, such as nausea and vomiting.
“Anybody who is in healthcare or has a family member who has had surgery knows that pain control is important, but narcotics can produce many adverse effects,” said G. Ying Li, MD, University of Michigan, Ann Arbor, Michigan. “Multimodal pain management makes for a much better experience for adolescents undergoing this procedure for scoliosis.”
For the current study, researchers examined the postoperative course of 50 adolescents with scoliosis who had spinal fusion surgery. Half were given intrathecal morphine only while the other 25 also received gabapentin before and after the procedure. All patients received Tylenol, ibuprofen, and a muscle relaxant.
Approximately half of the group who took gabapentin experienced nausea, vomiting, and itching after surgery, compared with over 70% to 80% of the group who received solely intrathecal morphine. The first group also had significantly lower mean total oxycodone consumption during the hospitalisation and had more consistent pain scores with fewer reported spikes.
“Our use of intrathecal morphine and transitioning directly to oral pain medications the day after surgery had already led to our patients getting discharged sooner after this surgery than at most other children’s hospitals because their pain was so well-controlled,” said Rebecca Hong, MD, University of Michigan. “However, we continually seek to improve our process, and our patients’ and their family’s satisfaction with the care they receive here. The addition of gabapentin has helped in regard to both metrics.”
Future studies are needed for clinicians to find the optimal dosing for the gabapentin-intrathecal morphine combination, the authors noted.
“What a lot of providers want is to be able to provide multimodal pain management, not just for kids and orthopaedic surgery,” said Dr. Hong. “During this opioid epidemic, we want to provide options that include non-narcotics to decrease the amount of narcotics we are prescribing and, ultimately, decrease the amount of leftover narcotics at home that can get into the wrong hands.”