Duration of intrathecal morphine effect in children with idiopathic scoliosis undergoing posterior spinal fusio

Bethany W. Ibach, PharmD; Carol Loeber, MSN, APRN-CNP; Mohanad Shukry, MD; Tracy M. Hagemann, PharmD, FCCP, FPPAG; Donald Harrison, PhD, FAPhA; Peter N. Johnson, PharmD, BCPS

doi:10.5055/jom.2015.0278

Authors

Bethany W. Ibach, PharmD
Carol Loeber, MSN, APRN-CNP
Mohanad Shukry, MD
Tracy M. Hagemann, PharmD, FCCP, FPPAG
Donald Harrison, PhD, FAPhA
Peter N. Johnson, PharmD, BCPS

DOI:

https://doi.org/10.5055/jom.2015.0278

Keywords:

morphine, intrathecal, scoliosis, spinal fusion, pediatrics, child

Abstract

Objective: Intrathecal (IT) morphine improves pain control and decreases opioid requirements in children following thoracic and abdominal surgery. However, studies in children report variable durations of analgesia following IT morphine. The purpose of this study is to describe the duration of analgesia in children undergoing surgical correction of idiopathic scoliosis.

Design: Retrospective chart review.

Setting: Pediatric hospital within a tertiary care academic medical center.

Participants: Forty-four pediatric patients with idiopathic scoliosis who received IT morphine following posterior spinal fusion (PSF).

Main outcome measure(s): Mean opioid exposure 0-12 hours and 13-24 hours post-IT morphine.

Results: Mean opioid exposure was significantly increased during the 13-24-hour compared to the 0-12-hour time period (23.0 ± 12.5 mg parenteral morphine vs 15.9 ± 1.7 mg; p = 0.0006). The only factors significantly associated with morphine exposure during the 0-12-hour period included the median pain score (0-12 hours) (odds ratio [OR], 1.92; 95% confidence interval [CI], 0.033-3.80; p = 0.046) and total acetaminophen dose (OR, 0.003; 95% CI, 0.0008-0.005; p = 0.011).

Conclusions: These data indicate that patients experienced improved analgesia for at least 12 hours following IT morphine. Increased use of adjuvant analgesics such as acetaminophen may reduce opioid requirements following PSF procedures. More studies are needed to investigate the combination of adjuvants and IT morphine to reduce postoperative pain in this population.

Author Biographies

Bethany W. Ibach, PharmD

Assistant Professor, Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas

Carol Loeber, MSN, APRN-CNP

Pediatric Pain Management Team, The Children’s Hospital at OU Medical Center, Oklahoma City, Oklahoma.

Mohanad Shukry, MD

Clinical Service Chief, Department of Anesthesiology, Children’s Hospital & Medical Center, Omaha, Nebraska.

Tracy M. Hagemann, PharmD, FCCP, FPPAG

Associate Dean, Nashville Campus, Professor, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Nashville, Tennessee

Donald Harrison, PhD, FAPhA

Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma.

Peter N. Johnson, PharmD, BCPS

Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma

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