Microdose Intrathecal Morphine Injection in Teenagers Undergoing Scoliosis Surgery Decreases Length of Stay, Pain Scores, and Opioid Consumption

Retrospective cohort study. This study aimed to investigate outcomes in Adolescent Idiopathic Scoliosis (AIS) patients undergoing posterior spinal fusion (PSF) with our institution's rapid recovery pathway (RRP) protocol that utilizes a microdose of ITM. Reducing opioid exposure among the adolescent population is extremely desirable. Microdose intrathecal morphine (ITM) has become common in labor and delivery surgery, among other subspecialties, because of the long-lasting analgesic properties. We hypothesized that this ITM-RRP protocol will reduce opioid consumption in this large sample. Retrospective cohort study of pediatric patients with spinal deformity who underwent posterior spinal fusion (PSF) between the years 2015 and 2023 were included. Patients before the implementation of RRP in 2018 were in the PCA group (2015-2017) and patients who underwent the procedure after the implementation of RRP (2018-2023) were in the ITM-RRP group. Outcomes measured include intraoperative, postoperative, and total opioid consumption, as well as length of stay, VAS pain scores, rate of emesis, and 90-day complications. ITM-RRP patients had lower VAS pain scores at activity ( P <0.001), were out of bed earlier ( P <0.001), were discharged earlier ( P <0.001), had lower rate of emesis ( P <0.001), and had their first stool earlier ( P <0.001) when compared with PCA patients. ITM-RRP patients consumed significantly less opioids intraoperatively ( P <0.001), postoperatively ( P <0.001), and overall ( P <0.001). ITM-RRP and PCA groups had similar rates of 90-day complications ( P =0.28) and respiratory complications ( P =0.94). ITM-RRP, which utilizes a microdose of morphine, is effective in managing postoperative pain after PSF. This is valuable because it allows for a reduction in not only the dosage of opioid exposure in adolescents but the duration as well, reducing the likelihood of opioid dependence in the future.