DG Journal Club
J Orthop Surg Res. 2022 Apr 18; 17(1): 241
BACKGROUND The purpose of this study was to evaluate the efficacy of intrathecal morphine (ITM) in combination with bupivacaine as pre-emptive analgesia in patients undergoing posterior lumbar fusion surgery. This is in comparison with traditional opioid analgesics such as intravenous (IV) morphine.
METHODS Two groups were identified retrospectively. The first (ITM group) included patients who had general anaesthesia (GA) with low-dose spinal anaesthesia prior to induction using 1-4B mls of 0.25% bupivacaine and 0.2B mg ITM. 1B ml of 0.25% bupivacaine was administered per hour of predicted surgery time, up to a maximum of 4B ml. The insertion level for the spinal anaesthetic corresponded to the spinal level of the iliac crest line and the level at which the spinal cord terminated. The control group had GA without any spinal anaesthesia. Patients were instead administered opioid analgesia in the form of IV morphine or diamorphine. The primary outcome was the consumption of opioids administered intraoperatively and in recovery, and over the first 48B h following discharge from the post-anaesthesia care unit (PACU). Total opioid dose was measured, and a morphine equivalent dose was calculated. Secondary outcomes included visual analogue scale (VAS) pain scores in recovery and at day two postoperatively, and the length of stay in hospital.
RESULTS For the ITM group, the median total amount of IV morphine equivalent administered intraoperatively and in recovery, was 0B mg versus 17B mg. The median total amount morphine equivalent, administered over the first 48B h following discharge from PACU was 20B mg versus 80B mg. Both are in comparison with the control group. The median length of stay was over 1B day less and the median VAS for pain in recovery was 6 points lower. No evidence was found for a difference in the worst VAS for pain at day two postoperatively.
CONCLUSION ITM in combination with bupivacaine results in a significantly decreased use of perioperative opioids. In addition, length of hospital stay is reduced and so too is patient perceived pain intensity. Trial registration The study was approved by the ethics committee at The Robert Jones and Agnes Hunt Orthopaedic Hospital as a service improvement project (Approval no. 1617_004).
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