{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T23:11:13Z","timestamp":1785453073901,"version":"3.56.0"},"reference-count":13,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2016,11,22]],"date-time":"2016-11-22T00:00:00Z","timestamp":1479772800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Posterior spinal fusion to correct idiopathic scoliosis is associated with severe postoperative pain. Intrathecal morphine is commonly used for analgesia after adolescent posterior spinal fusion; however, anticipating and managing the increase in pain scores after resolution of analgesic effect of intrathecal morphine analgesia is challenging. In 2014, we developed a clinical protocol detailing both the administration of intrathecal morphine intraoperatively and the transition to routine, scheduled oral analgesics at 18 h postoperatively. The goal of our study was to examine the efficacy of our intrathecal morphine protocol vs epidural hydromorphone for postoperative analgesia after posterior spinal fusion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Following <jats:styled-content style=\"fixed-case\">IRB<\/jats:styled-content> approval, we retrospectively identified developmentally intact children of ages 10\u201320 years in our electronic database with a diagnosis of idiopathic scoliosis who had undergone elective posterior spinal fusion surgery from June 2014 to April 2015. For the intrathecal morphine group, intrathecal morphine was administered in a dose of 12 \u03bcg\u00b7kg<jats:sup>\u22121<\/jats:sup> (max 1000 \u03bcg) prior to incision. Postoperatively, all children in the intrathecal morphine group had an order to receive oral oxycodone (0.1 mg\u00b7kg<jats:sup>\u22121<\/jats:sup>, max 5 mg) starting at 18 h postintrathecal morphine injection. For the epidural hydromorphone group, catheters were placed by the surgeon and bolused with 5 \u03bcg\u00b7kg<jats:sup>\u22121<\/jats:sup> hydromorphone (max 200 \u03bcg) and 1 \u03bcg\u00b7kg<jats:sup>\u22121<\/jats:sup> fentanyl (max 50 \u03bcg), followed by a continuous infusion of 40\u201360 \u03bcg\u00b7h<jats:sup>\u22121<\/jats:sup>, and patient\u2010controlled bolus doses of 5 \u03bcg with a lockout interval of 30 min. All patients in both groups had postoperative orders for acetaminophen, diazepam, and ketorolac.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>During the study time period, 20 patients received intrathecal morphine and were successfully matched with 20 patients who received epidural hydromorphone. All patients in the intrathecal morphine group were transitioned to oral analgesics on the first postoperative day, without need for intravenous opioids after discharge from the postanesthesia care unit. Compared to the epidural hydromorphone group, the intrathecal morphine group reported lower pain scores in the postanesthesia care unit (difference in means \u22124.26 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22126.56, \u22121.96], <jats:italic>P<\/jats:italic> = 0.001) and first 8 h after surgery (difference in means \u22121.88 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> \u22123.84, 0.082, <jats:italic>P<\/jats:italic> = 0.060) and higher pain scores on the 2nd postoperative day (difference in means 1.60 [95% <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content> 0.10, 3.10], <jats:italic>P<\/jats:italic> = 0.037). The documented time to ambulation and time of Foley catheter removal were statistically earlier in the intrathecal morphine group, and the hospital length of stay was significantly shorter (3.0 \u00b1 0.5 days vs 3.5 \u00b1 0.7 days; <jats:italic>P<\/jats:italic> = 0.03). Adverse events did not significantly differ between the groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The efficacy of intraoperative intrathecal morphine for postoperative analgesia in the posterior spinal fusion patient population has been shown previously; however, the pain and analgesic trajectory, including transition to other analgesics, has not previously been studied. Our findings suggest that for many patients, use of intrathecal morphine in addition to routine administration of nonopioid medications facilitates direct transition to oral analgesics in the early postoperative period and earlier routine ambulation and discharge of posterior spinal fusion patients.<\/jats:p><\/jats:sec>","DOI":"10.1111\/pan.13037","type":"journal-article","created":{"date-parts":[[2016,11,23]],"date-time":"2016-11-23T04:20:43Z","timestamp":1479874843000},"page":"91-97","source":"Crossref","is-referenced-by-count":40,"title":["A retrospective comparison of intrathecal morphine and epidural hydromorphone for analgesia following posterior spinal fusion in adolescents with idiopathic scoliosis"],"prefix":"10.1111","volume":"27","author":[{"given":"Rebecca A.","family":"Hong","sequence":"first","affiliation":[{"name":"Division of Pediatric Anesthesiology Department of Anesthesiology University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen M.","family":"Gibbons","sequence":"additional","affiliation":[{"name":"Division of Pediatric Anesthesiology Department of Anesthesiology University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G. Ying","family":"Li","sequence":"additional","affiliation":[{"name":"Division of Pediatric Orthopaedic Surgery Department of Orthopaedic Surgery University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashlee","family":"Holman","sequence":"additional","affiliation":[{"name":"Division of Pediatric Anesthesiology Department of Anesthesiology University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terri","family":"Voepel\u2010Lewis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Anesthesiology Department of Anesthesiology University of Michigan Ann Arbor MI USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2016,11,22]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3181b2ba08"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1460-9592.2009.03226.x"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e3181a90ceb"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ANE.0000107938.80562.75"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/BRS.0b013e31817bd8be"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0b013e3182694f00"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1213\/01.ane.0000252418.05394.28"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000490"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aen025"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/00007632-200203010-00015"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.brs.0000163884.11476.25"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/aeu296"},{"key":"e_1_2_9_14_1","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1097\/ALN.0b013e31823d012a","article-title":"Risk factors associated with ischemic optic neuropathy after spinal fusion surgery","volume":"116","author":"Lee LA","year":"2012","journal-title":"Anesthesiology"}],"container-title":["Pediatric Anesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fpan.13037","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/pan.13037","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,2]],"date-time":"2023-10-02T06:56:38Z","timestamp":1696229798000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/pan.13037"}},"subtitle":[],"editor":[{"given":"Adrian","family":"Bosenberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2016,11,22]]},"references-count":13,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2017,1]]}},"alternative-id":["10.1111\/pan.13037"],"URL":"https:\/\/doi.org\/10.1111\/pan.13037","archive":["Portico"],"relation":{},"ISSN":["1155-5645","1460-9592"],"issn-type":[{"value":"1155-5645","type":"print"},{"value":"1460-9592","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,11,22]]}}}