{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:56:24Z","timestamp":1791374184682,"version":"4.3.1"},"reference-count":21,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T00:00:00Z","timestamp":1791331200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100000871","name":"Mayo Clinic","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000871","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Anesthesia"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Intrathecal opioids are widely used for postoperative analgesia in pediatric spine surgery, but optimal dosing remains undefined. We evaluated the relationship between intrathecal hydromorphone (ITH) dose, analgesia, and adverse effects in adolescents undergoing posterior spinal fusion (PSF).<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this single\u2010center, prospective, blinded dose\u2010escalation study using a biased\u2010coin up\u2010down sequential allocation design, patients aged 10\u201317\u2009years undergoing PSF received ITH starting at 3.5\u2009mcg\u2009kg\n \u22121<\/jats:sup>\n , with dose adjustments based on analgesic response (range 2.0 to 7\u2009mcg\u2009kg\n \u22121<\/jats:sup>\n with a maximum of 400\u2009mcg). The primary outcome was maximum postoperative pain within 18\u2009h. Secondary outcomes included pain burden (area under the curve), 24\u2010h systemic opioid consumption (oral morphine equivalents [OME], excluding ITH), adverse effects, supplemental diazepam use, and rescue opioid use. Associations between dose and outcomes were assessed using Spearman correlation and logistic regression.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Twenty\u2010seven patients completed the study. The median ITH dose received was 5.5\u2009mcg\u2009kg\n \u22121<\/jats:sup>\n (IQR, 3.5\u20137.0), with a median absolute dose of 370\u2009mcg (IQR, 180\u2013400). No significant association was observed between ITH dose and maximum pain (\n r<\/jats:italic>\n \u2009=\u20090.16,\n p<\/jats:italic>\n \u2009=\u20090.41), pain burden (\n r<\/jats:italic>\n \u2009=\u20090.32,\n p<\/jats:italic>\n \u2009=\u20090.10), or 24\u2010h OME (\n r<\/jats:italic>\n \u2009=\u20090.13,\n p<\/jats:italic>\n \u2009=\u20090.52). ITH dose was not significantly associated with the time to rescue opioid (HR\u2009=\u20091.24; 95% CI 0.68\u20132.25;\n p<\/jats:italic>\n \u2009=\u20090.485) or diazepam (HR\u2009=\u20091.10; 95% CI 0.72\u20131.71;\n p<\/jats:italic>\n \u2009=\u20090.655). Adverse respiratory events occurred at doses >\u20095\u2009mcg\u2009kg\n \u22121<\/jats:sup>\n without improved analgesia.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Increasing ITH dose was not associated with improved analgesia or change in supplemental opioid or diazepam use. Doses >\u20095\u2009mcg\u2009kg\n \u22121<\/jats:sup>\n were associated with adverse respiratory effects. These findings support conservative dosing strategies and underscore the need to define the minimum effective dose in pediatric populations.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/pan.70325","type":"journal-article","created":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T11:36:53Z","timestamp":1791373013000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Intrathecal Hydromorphone Dosing for Adolescent Spinal Fusion: A Prospective Dose\u2010Escalation Study"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5456-3453","authenticated-orcid":false,"given":"Kathryn S.","family":"Handlogten","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1473-7084","authenticated-orcid":false,"given":"Lindsay L.","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6542-6975","authenticated-orcid":false,"given":"A. Noelle","family":"Larson","sequence":"additional","affiliation":[{"name":"Division of Pediatric Orthopedic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd A.","family":"Milbrandt","sequence":"additional","affiliation":[{"name":"Division of Pediatric Orthopedic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anthony A.","family":"Stans","sequence":"additional","affiliation":[{"name":"Division of Pediatric Orthopedic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2528-317X","authenticated-orcid":false,"given":"Emmanouil","family":"Grigoriou","sequence":"additional","affiliation":[{"name":"Division of Pediatric Orthopedic Surgery Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darrell R.","family":"Schroeder","sequence":"additional","affiliation":[{"name":"Division of Clinical Trials and Biostatistics Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O.","family":"Warner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine Mayo Clinic Rochester Minnesota USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,7]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1111\/pan.14895","article-title":"A Survey of Practice in the Anesthetic Management of Adolescent Idiopathic Scoliosis Spine Fusion by the North American Pediatric Spine Anesthesiologists Collaborative","volume":"34","author":"Gilbertson L. 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