title: Duration of intrathecal morphine effect in children with idiopathic scoliosis undergoing posterior spinal fusion.
abstract: OBJECTIVE
  Intrathecal (IT) morphine improves pain control and decreases opioid requirements in children following thoracic and abdominal surgery. However, studies in children report variable durations of analgesia following IT morphine. The purpose of this study is to describe the duration of analgesia in children undergoing surgical correction of idiopathic scoliosis.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Pediatric hospital within a tertiary care academic medical center.
  
  
  METHODS
  Forty-four pediatric patients with idiopathic scoliosis who received IT morphine following posterior spinal fusion (PSF).
  
  
  METHODS
  Mean opioid exposure 0-12 hours and 13-24 hours post-IT morphine.
  
  
  RESULTS
  Mean opioid exposure was significantly increased during the 13-24-hour compared to the 0-12-hour time period (23.0 ± 12.5 mg parenteral morphine vs 15.9 ± 1.7 mg; p = 0.0006). The only factors significantly associated with morphine exposure during the 0-12-hour period included the median pain score (0-12 hours) (odds ratio [OR], 1.92; 95% confidence interval [CI], 0.033-3.80; p = 0.046) and total acetaminophen dose (OR, 0.003; 95% CI, 0.0008-0.005; p = 0.011).
  
  
  CONCLUSIONS
  These data indicate that patients experienced improved analgesia for at least 12 hours following IT morphine. Increased use of adjuvant analgesics such as acetaminophen may reduce opioid requirements following PSF procedures. More studies are needed to investigate the combination of adjuvants and IT morphine to reduce postoperative pain in this population.
authors: Assistant Professor, Department of Pharmacy Practice, Texas Tech University Health Sciences Center School of Pharmacy, Abilene, Texas.
authors: Bethany W
authors: BW
authors: Ibach
authors: Pediatric Pain Management Team, The Children's Hospital at OU Medical Center, Oklahoma City, Oklahoma.
authors: Carol
authors: C
authors: Loeber
authors: Clinical Service Chief, Department of Anesthesiology, Children's Hospital & Medical Center, Omaha, Nebraska.
authors: Mohanad
authors: M
authors: Shukry
authors: Associate Dean, Nashville Campus, Professor, Department of Clinical Pharmacy, University of Tennessee College of Pharmacy, Nashville, Tennessee.
authors: Tracy M
authors: TM
authors: Hagemann
authors: Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma.
authors: Donald
authors: D
authors: Harrison
authors: Associate Professor, Department of Pharmacy: Clinical and Administrative Sciences, University of Oklahoma College of Pharmacy, Oklahoma City, Oklahoma.
authors: Peter N
authors: PN
authors: Johnson
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage; D000293:Adolescent; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000493:pharmacokinetics; D002648:Child; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D006801:Humans; D007278:Injections, Spinal / Q000379:methods; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000493:pharmacokinetics; D059408:Pain Management / Q000379:methods; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy; D012189:Retrospective Studies; D012600:Scoliosis / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects* / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine