Comparison of high- and low-dose intrathecal morphine for spinal fusion in children.
BACKGROUND
The purpose of this prospective study was to assess the blood-sparing effect, the quality of analgesia, and the incidence of side-effects of a low-dose regime of intrathecal opioids (ITO) when compared with those of a high-dose regime in scoliosis surgery in children.


METHODS
Forty-six children were randomly included into one of the three groups to receive morphine 5 microg kg(-1) plus sufentanil 1 microg kg(-1) [low-dose intrathecal opioid (LITO)], morphine 15 microg kg(-1) plus sufentanil 1 microg kg(-1) [high-dose intrathecal opioid (HITO)] intrathecally, or no intrathecal opioid. Postoperative analgesia was provided by i.v. opioids. Intraoperative blood loss, postoperative quality of analgesia, opioid requirements, and the incidence of side-effects were recorded for 3 days.


RESULTS
Intraoperative blood loss was significantly reduced by ITOs [LITO: 41.4 (sd 18.8) ml kg(-1); HITO: 37.5 (6.9) ml kg(-1); control: 76.9 (15.3) ml kg(-1), P<0.001], with no difference between the two intrathecal opioid groups. Mean pain scores on the day of surgery were lower in both intrathecal opioid groups (LITO: 2.2 and HITO: 2.1) when compared with the control group (4.1, P<0.03) and opioid consumption was significantly decreased [LITO: 304.3 (65.0) microg kg(-1); HITO: 224.1 (51.8) microg kg(-1); control: 667.7 (89.5) microg kg(-1), P<0.002]. Side-effects of intrathecally administered opioids were similarly frequent in all groups.


CONCLUSIONS
Intrathecal administration of opioids significantly reduces blood loss and postoperative opioid demand, thereby showing side-effects comparable with the control group. These effects were already seen with the low-dose regimen and high dose did not further improve efficacy.
Eschertzhuber
S
S
Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria. stephan.eschertzhuber@i-med.ac.at
Hohlrieder
M
M
Keller
C
C
Oswald
E
E
Kuehbacher
G
G
Innerhofer
P
P
D000293:Adolescent; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D004305:Dose-Response Relationship, Drug; D006801:Humans; D007278:Injections, Spinal; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D016037:Single-Blind Method; D013123:Spinal Fusion
D000701:Analgesics, Opioid; D009020:Morphine