title: [Intrathecal opioid medication for perioperative analgesia in severely handicapped children undergoing spinal operations].
abstract: OBJECTIVE
  Intrathecal opioids have been shown to be safe and effective for postoperative analgesia in healthy children for spinal surgery. The aim of this study was to evaluate the applicability of intrathecal opioids in severely handicapped children scheduled for spinal surgery.
  
  
  METHODS
  With hospital ethical committee approval, patients with physical states III and IV of the ASA classification requiring spinal surgery were retrospectively studied. In addition to inhalational anesthesia with sevoflurane or intravenous anesthesia using propofol, morphine 20 microg/kgBW and sufentanil 1.5 microg/kgBW were administered intrathecally before surgery. After surgery an infusion of nalbuphine was started. Need for additional intraoperative and postoperative analgesics, time of extubation, postoperative pain scores and p(a)CO2 values as well as adverse effects were recorded.
  
  
  RESULTS
  A total of 28 patients aged from 2.8 to 18.5 years (median 11.6 years) were studied. Immediate tracheal extubation in the operating room was possible in 17 patients and for 11 patients delayed extubation was elected. All patients were extubated within 24 h except for 1 patient who received massive postoperative transfusions. In 26 out of 28 patients (93%) the combination of intrathecal opioids with postoperative nalbuphine provided adequate analgesia. Observed side effects were post-operative nausea and vomiting (PONV), pruritus and moderate hypoventilation. In two patients a change to intravenous morphine therapy was necessary.
  
  
  CONCLUSIONS
  The use of intrathecal opioids for perioperative pain control from spinal fusion in severely handicapped children is feasible. Intrathecal opioids provide adequate postoperative analgesia and allow early extubation without persisting relevant respiratory compromise in most of these patients.
authors.affiliation: Anästhesieabteilung, Universitäts-Kinderkliniken Zürich, Steinwiesstr. 75, 8032 Zürich, Schweiz. achim.schmitz@kispi.uzh.ch
authors.forename: A
authors.initials: A
authors.lastname: Schmitz
authors.forename: B
authors.initials: B
authors.lastname: Salgo
authors.forename: M
authors.initials: M
authors.lastname: Weiss
authors.forename: C M
authors.initials: CM
authors.lastname: Dillier
authors.forename: A
authors.initials: A
authors.lastname: Frotzler
authors.forename: A C
authors.initials: AC
authors.lastname: Gerber
mesh_terms: D000293:Adolescent; D000698:Analgesia; D000701:Analgesics, Opioid / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D053208:Kaplan-Meier Estimate; D008297:Male; D009266:Nalbuphine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D010146:Pain / Q000188:drug therapy* / Q000209:etiology; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D019990:Perioperative Care; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control; D011537:Pruritus / Q000139:chemically induced / Q000453:epidemiology; D012189:Retrospective Studies; D013131:Spine / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid; D009266:Nalbuphine