1276. Outcomes Following Use of Spinal Morphine Analgesia in Lumbar Spine Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Studies
Award: Third Place Pain Eposter Award
Authors: Mohamad Bydon, MD, FAANS ; Anshit Goyal, MBBS; Elena Blaginykh, MD, MPH; Waseem Wahood, MS; Mohammed Alvi, MBBS (Rochester, MN)
Epidural and intrathecal opioids are effective means of postoperative analgesia in lumbar spine surgery. However, their use is limited by adverse events such as respiratory depression. We performed a systematic review and meta-analysis of current randomized controlled studies to compare outcomes following use of spinal morphine against other intraoperative analgesic alternatives.
A literature search was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for article screening and inclusion. We included prospective randomized studies with at least 5 adult (>18) patients in each group undergoing lumbar spine surgery with use of either spinal (intrathecal or epidural) morphine or other analgesic alternatives for post-operative pain control. Given heterogeneity in control groups, random-effects meta-analysis was performed to compare outcomes such as complication rates, postoperative analgesic requirements and pain control as measured by the Visual Analog Scale (VAS-BP).
Seven studies (n=592 patients) were included with 376 (63.5%) receiving spinal morphine. All patients received postoperative narcotics either by patient controlled analgesia or on-demand parenteral administration. Compared to controls (local anesthetic/no morphine /normal saline) patients receiving intrathecal/epidural morphine showed lower postoperative VAS scores (Mean Difference (SMD): -0.31,CI:-0.94to0.33, p<0.001, I2=89%) and opioid analgesic requirements (SMD: -1.92,CI: -3.74to-0.11, p<0.001, I2=96%). No difference was observed in rate of nausea/vomiting (OR: 0.93, CI: 0.25-3.49, p=0.91, I2=84%), urinary retention (OR: 1.67, CI:0.80-3.48, p=0.17, I2=44%) and apneic episodes (OR: 1.21,CI: 0.33-4.51, p=0.77, I2=53%). However, pruritus (OR: 4.56,CI: 2.3-9.04, p<0.001, I2=0%) was found to be higher with spinal administration of morphine.
Use of intrathecal and epidural morphine may be associated with improved post-operative pain control and decreased postoperative analgesic requirements with a safety profile comparable to other intraoperative analgesic alternatives.