PT  - JOURNAL ARTICLE
AU  - Baxter, Samantha N.
AU  - Brennan, Jane C.
AU  - Johnson, Andrea H.
AU  - Stock, Laura
AU  - King, Regan
AU  - Gelfand, Jake
AU  - Andersen, Kristina
AU  - Pipkin, Karen M.
AU  - Turcotte, Justin
AU  - Patton, Chad M.
TI  - The Effect of Preoperative, Low-Dose Intrathecal Morphine on Patient Outcomes Following Lumbar Fusion Surgery: Can We Teach an Old Dog New Tricks?
AID  - 10.14444/8532
DP  - 2023 Oct 01
TA  - International Journal of Spine Surgery
PG  - 721--727
VI  - 17
IP  - 5
4099  - https://www.ijssurgery.com/content/17/5/721.short
4100  - https://www.ijssurgery.com/content/17/5/721.full
SO  - Int J Spine Surg2023 Oct 01; 17
AB  - Background Early pain control after lumbar fusion presents a challenge to patients and providers. Intrathecal morphine (ITM) has been used at the end of these procedures with limited benefit, but recent data suggest low-dose ITM at case initiation may be effective. This study aims to evaluate the use of preoperative ITM during lumbar fusion to determine whether there is a benefit for these patients.Methods One hundred and eighty lumbar fusion patients between 1 January 2018 and 31 May 2022 were evaluated. Patients were grouped by whether they received preoperative, low-dose ITM or not. Outcomes of interest included hospital narcotic consumption, pain scores, opioid-related complications, and complications within the first 90 days.Results Sixty-five study patients received 200 µg ITM at case initiation and 115 did not. No differences in length of stay, discharge disposition, or complications in the first 90 days were noted. ITM patients received fewer milligram morphine equivalents in the postanesthesia care unit (9.7 ± 31.23 vs 21.83 ± 21.07; P = 0.006) and on postoperative day 0 (18.60 ± 35.47 vs 35.47 ± 28.51; P = 0.001). Pain scores were lower in the ITM group both in the postanesthesia care unit and on postoperative day 0, with a decrease in extreme pain scores (>7; 35.4% vs 53.0%; P = 0.034).Conclusions ITM appears to be safe and effective for reducing early pain and narcotic consumption on the day of surgery for lumbar fusion patients and may hold value for incorporation into rapid recovery protocols and for improving pain-related patient satisfaction.Clinical Relevance ITM appears to be safe and effective for reducing early pain and narcotic consumption on the day of surgery for lumbar fusion patients and may hold value for incorporation into rapid recovery protocols and for improving pain-related patient satisfaction.Level of Evidence 3.