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BJA Advance Access originally published online on February 27, 2008
British Journal of Anaesthesia 2008 100(4):538-543; doi:10.1093/bja/aen025
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2008. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Comparison of high- and low-dose intrathecal morphine for spinal fusion in children

S. Eschertzhuber1,*, M. Hohlrieder1, C. Keller1, E. Oswald1, G. Kuehbacher2 and P. Innerhofer1

1 Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria
2 Department of Anaesthesiology and Critical Care Medicine, Hall i.T. County Hospital, Milser Strasse 10, 6060 Hall in Tirol, Austria

* Corresponding author. E-mail: stephan.eschertzhuber{at}i-med.ac.at

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 µg kg–1 plus sufentanil 1 µg kg–1 [low-dose intrathecal opioid (LITO)], morphine 15 µg kg–1 plus sufentanil 1 µg 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) µg kg–1; HITO: 224.1 (51.8) µg kg–1; control: 667.7 (89.5) µg 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.

Keywords: children; analgesics, opioid; surgery, spinal


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