Intrathecal morphine analgesia after cervical and thoracic spinal cord tumor surgery

Poblete, Beate; Konrad, Christoph; Kothbauer, Karl F.

doi:10.3171/2014.8.spine1436

Cited by 9 publications

(5 citation statements)

References 33 publications

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“…Demircan comments on a study by Ross, et al, where a prospective, double-blind, placebo-controlled study of the use of intrathecal morphine after lumbar spinal surgery, showing that patients receiving intrathecal morphine saw a reduction in parenteral narcotics over the course of their hospitalization as well as a reduction in the mean length of hospitalization when compared to patients who had systemic narcotic administration [ 5 , 14 ]. Another study from Poblete, et al also showed that patients that received intrathecal morphine after cervical or thoracic spinal cord tumor surgery reported their highest pain scores immediately postoperatively with a decline at 12 hours postoperatively, along with minimal extra morphine being necessary throughout their hospitalization [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Use of Intrathecal Morphine for Spinal Three Column Osteotomy

Audlin

Kurra

Lavelle

et al. 2017

Cureus

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IntroductionThe use of intrathecal morphine has the potential to help alleviate the pain that patients experience undergoing spinal surgeries. Complications can cause immobilization, which can lead to vascular thrombosis and ileus. Studies have shown epidural analgesia significantly lowered postoperative pain scores in scoliosis surgeries. Intrathecal anesthesia has been shown to have good pain control over the initial 24-hour postoperative period.PurposeDetermine if intrathecal morphine would reduce postoperative pain with minimal side effects.MethodsThe surgical case logs from three spinal deformity surgeons from a single academic medical center were reviewed retrospectively. This included cases where more than five levels of fusion occurred and surgery involved an osteotomy. The records of 17 patients were queried, and patient and surgical data were collected. The patients were divided into two groups: eight patients were administered intrathecal morphine and nine patients received no morphine. Postoperative pain scores were obtained hourly over the initial 24 hours postoperatively by nurses trained to obtain pain scores from the Numeric Pain Rating Scale. In addition, the rates of any noted side effects were recorded. Analysis of variance (ANOVA) and Fisher’s exact tests were used to calculate any statistical significance with p < 0.05 considered to be significant.ResultsThe maximum and total 24-hour postoperative pain scores had a mean of 5.6 (standard deviation = 4.2; p = 0.4266) and 69.3 (standard deviation = 57.8; p = 0.9189), respectively, for patients administered intrathecal morphine. The patients who did not receive intrathecal morphine had total pain scores of 3.9 (standard deviation = 4.5) and 65.7 (standard deviation = 79.7), respectively. Though the results were not statistically significant, there was a potential trend toward decreased in pain mean scores in the first 10 hours for the intrathecal morphine group. There was no statistical difference in the rate of side effects between patients.ConclusionsThe use of intrathecal morphine did not significantly appear to reduce postoperative pain in patients when compared to intravenous or oral narcotics. There was a potential trend in a reduction in postoperative pain during the first 10 hours postoperatively, but this did not reach a statistically significant value and did not hold up after the first 10 hours postoperatively. However, it was noted that intrathecal morphine was safe to use in postoperative spinal deformity surgery as no statistical significance in side effects was noted.

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Section: Discussionmentioning

confidence: 99%

Safety and Efficacy of the Use of Intrathecal Morphine for Spinal Three Column Osteotomy

Audlin

Kurra

Lavelle

et al. 2017

Cureus

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“…A regional anesthesia technique for simple spinal surgery procedure includes standard spinal and epidural anesthesia, intrathecal administration of opioids and cervical plexus block ( 4 , 11 , 12 , 16 ). Spinal anesthesia is most frequently used.…”

Section: Regional Anesthesia Techniques For Spinal Surgerymentioning

confidence: 99%

“…Because of the potential hazard of severe hypotension during prone position and the need to convert anesthesia to general, it is wise to anticipate the difficult airway management plan beforehand. In literature there are no benefits of regional anesthesia versus general for spine surgery in terms of morbidity and mortality, however some short-term benefits of regional anesthesia have been demonstrated - for example reduction in hypertension and tachycardia, postoperative pain, postoperative nausea and vomiting, and analgesic requirement in the post anesthesia care unit ( 11 , 12 , 16 ).…”

Section: Regional Anesthesia Techniques For Spinal Surgerymentioning

confidence: 99%

“…Epidural local anesthetic administration could compromise postoperative neurologic assessment because of motor block, so its administration should be discussed with the surgeon preoperatively and it is best avoided in certain patients who might need quick neurological evaluation postoperatively. Opioid of choice for intrathecal administration is morphine with a dose of 10mcg/kg ( 12 , 17 ). Maximum dose for adultsof 0.4 mg has been suggested because of the risk of opioid side effects (respiratory depression).…”

Section: Regional Anesthesia Techniques For Spinal Surgerymentioning

confidence: 99%

“…Most frequently it is performed in addition to general anesthesia for decreasing postoperative pain. Most frequently used methods are spinal anesthesia, intrathecal application of opioids and epidural catheter application for postoperative pain decrease ( 11 , 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Regional Anaesthesia for Neurosurgery

Tonković

Pavlović

Baronica

et al. 2019

ACC

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SummaryDuring neurosurgery procedures it is vital to assure optimal cerebral perfusion and oxygenation. Despite physiological autoregulation of brain perfusion, maintaining hemodynamic stability and good oxygenation during anesthesia is vital for success. General anesthesia with mechanical ventilation and current drugs provide excellent hemodynamic condition and it is the first choice for most neurosurgery procedures. However, sometimes it is very hard to avoid brief increase or decrease in blood pressure especially during period of intense pain, or without pain stimulation. This could be detrimental for patients presented with high intracranial pressure and brain edema. Modifying anesthesia depth or treatment with vasoactive drugs usually is needed to overcome such circumstances. On the other hand it is important to wake the patients quickly after anesthesia for neurological exam. That is why regional anesthesia of scalp and spine could show beneficial effects by decreasing pain stimuli and hemodynamic variability with sparing effect of anesthetics drugs. Also regional techniques provide excellent postoperative pain relief, especially after spinal surgery

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