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The Effect of Preoperative, Low-Dose Intrathecal Morphine on Patient Outcomes Following Lumbar Fusion Surgery: Can We Teach an Old Dog New Tricks? – Lumbar Fusion

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The article evaluates the use of preoperative intrathecal morphine (ITM) during lumbar fusion surgery to determine its effectiveness in controlling pain and reducing narcotic consumption. A total of 180 patients who underwent lumbar fusion between January 2018 and May 2022 were included in the study. Outcomes such as hospital narcotic consumption, pain scores, opioid-related complications, and complications within the first 90 days were assessed. The results showed that patients who received low-dose ITM before surgery had lower pain scores and consumed fewer narcotics after the procedure compared to those who did not receive ITM. Additionally, there were no differences in length of stay or complications observed. The study suggests that ITM may be safe and beneficial for managing early postoperative pain and reducing narcotic consumption in lumbar fusion patients, potentially improving patient satisfaction

Summarised by Mr Mo Akmal – Lead Spinal Surgeon
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Published article

S: 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.

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Int J Spine Surg. 2023 Oct 12:8532. doi: 10.14444/8532. Online ahead of print.ABSTRACTBACKGROUND: 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,

Int J Spine Surg. 2023 Oct 12:8532. doi: 10.14444/8532. Online ahead of print.

ABSTRACT

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).

S: 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.

PMID:37827707 | DOI:10.14444/8532

The London Spine Unit : best situated treatment facility in the world

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The Effect of Preoperative, Low-Dose Intrathecal Morphine on Patient Outcomes Following Lumbar Fusion Surgery: Can We Teach an Old Dog New Tricks?

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Int J Spine Surg. 2023 Oct 12:8532. doi: 10.14444/8532. Online ahead of print.ABSTRACTBACKGROUND: 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
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