Abstract Preview - Step 3/4
Learning Track:
5. Paediatric Anaesthesiology
Title:
A Comparison of intrathecal diamorphine with systemic analgesia following adolescent idiopathic scoliosis surgery
Author(s):
Krishnan R., Ng T., Brinkler R., Vijayaraghavan R.
Institute(s):
Royal National Orthopaedic Hospital, Dept of Anaesthesiology & Intensive Care, Stanmore, United Kingdom
Text:
Background and Goal of Study: Scoliosis surgery can result in severe post-operative pain. The current standard of post-operative pain management consists of opioid-based patient controlled analgesia. To achieve satisfactory pain control, high doses of opioids are administered, resulting in adverse effects such as nausea and vomiting, constipation, pruritus and respiratory depression.
Recently, alternative methods of delivering analgesia have been studied. Intrathecal morphine following spinal surgery is associated with an increased incidence of late respiratory depression. There are currently no studies that compare intrathecal diamorphine with systemic methods of analgesia following scoliosis surgery. The aim of our study is to compare the safety and efficacy of spinal diamorphine with systemic analgesia in patients undergoing adolescent idiopathic scoliosis surgery.
Materials and methods: This was a retrospective comparative observational study. Data collection was performed via a review of patient notes. Children under 18 years of age with adolescent idiopathic scoliosis undergoing single stage posterior fusion performed by two surgeons were included. The anaesthetist injected spinal diamorphine with the patient under general anaesthesia prior to the surgical incision. Data collected included: patient demographics, perioperative analgesic requirements and pain scores in recovery and for up to 48 hours postoperatively, estimated blood loss (EBL), side effects, critical care and hospital length of stay, indicators of gastrointestinal function (postoperative number of days needed to establish oral intake and bowel opening). Statistical analysis was performed using a standard t-test.
Results and discussion: 60 children were included in the study with 30 having spinal diamorphine and 30 having no spinal diamorphine. Patients in the diamorphine had less opioid consumption and less pain scores in the recovery and for up to 48 hours after surgery. One patient in the spinal diamorphine had respiratory depression and was managed with naloxone boluses without airway intervention.
Conclusion(s): Spinal diamorphine provides better analgesia than conventional methods following scoliosis surgery. Future dose dependent studies are needed to find out the optimum dose of intrathecal diamorphine which would maximise the benefits without increase in side effects.
Ethical Research Declaration:
2. Retrospective data review
Preferred Presentation Type:
Clinical or experimental study