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Continuous Intravenous Morphine Infusion for Postoperative Analgesia Following Posterior Spinal Fusion for Idiopathic Scoliosis

Poe-Kochert, Connie RN, CNP*; Tripi, Paul A. MD†; Potzman, Jennifer MD†; Son-Hing, Jochen P. MD, FRCSC*; Thompson, George H. MD*

doi: 10.1097/BRS.0b013e3181bc9a00
Deformity

Study Design. A retrospective study of postoperative pain management.

Objective. Evaluate the efficacy and safety of continuous intravenous morphine infusion for postoperative pain management in patients with idiopathic scoliosis (IS) undergoing posterior spinal fusion (PSF) and segmental spinal instrumentation (SSI).

Summary of Background Data. Postoperative pain is a common problem following surgery for IS. There are no published reports regarding the use of a continuous intravenous morphine infusion for this patient population.

Methods. We retrospectively reviewed data regarding 339 consecutive patients with IS who underwent PSF and SSI between 1992 and 2006. All patients received intrathecal morphine after the induction of general anesthesia. Following surgery, preordered morphine infusion (0.01 mg/kg/h) was started at first reported pain. The infusion rate was titrated based on vital signs, visual analog scale (VAS) pain scores (0–10), and clinical status. It was continued until patients were able to take oral analgesics. We reviewed intrathecal morphine dosage, VAS pain scores through the third postoperative day, interval to start of morphine infusion, total morphine requirements in the first 48 hours, and any adverse reactions (nausea/vomiting, pruritus, respiratory depression, and pediatric intensive care unit admission).

Results. Mean intrathecal morphine dose was 15.5 ± 3.9 μg/kg and mean interval to start of the intravenous morphine infusion was 17.5 ± 5 hours. Mean VAS pain scores were 3.1, 4.5, 4.5, and 4.6 at 12 hours, 1, 2, and 3 days after surgery, respectively.

The total mean morphine dose in the first 48 hours postoperatively was 0.03 ± 0.01 mg/kg/h. Total morphine received was 1.44 ± 0.5 mg/kg. Nausea/vomiting and pruritus, related to the morphine infusion occurred in 45 patients (13.3%) and 14 patients (4.1%), respectively. No patients had respiratory depression or required Pediatric Intensive Care Unit admission.

Conclusion. A low frequency of adverse events and a mean postoperative VAS pain score of 5 or less demonstrate that a continuous postoperative morphine infusion is a safe and effective method of pain management in patients with IS following PSF and SSI.

Continuous postoperative morphine infusion in 339 consecutive postoperative patients with idiopathic scoliosis demonstrated effective pain control in the first 48 hours after its initiation and a low incidence of adverse reactions, such as nausea/vomiting and pruritus. There were no cases of respiratory depression and Pediatric Intensive Care Unit admission. The total mean dose of morphine was low at 0.03 mg/kg/h and total morphine received was 1.44 mg ± 0.5 mg/kg. We feel this method is a safe, effective technique for postoperative pain control in idiopathic scoliosis.

From the Divisions of *Pediatric Orthopaedics and †Pediatric Anesthesiology, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH.

Acknowledgment date: February 24, 2009. First revision date: June 11, 2009. Second revision date: July 8, 2009. Acceptance date: July 13, 2009.

The device(s)/drug(s) is/are FDA-approved or approved by corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to George H. Thompson, MD, Division of Pediatric Orthopaedics, Rainbow Babies and Children's Hospital, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH 44106; E-mail: ght@po.cwru.edu

© 2010 Lippincott Williams & Wilkins, Inc.