117. Zero PCA is an achievable target for postoperative rapid recovery management of AIS patients

Abstract

BACKGROUND CONTEXT Studies have shown that narcotic substance addiction has been on a rise across all patient populations, including pediatrics. Narcotics have long been used in complex spine surgeries as a measure of pain control, and are often given in the form of patient-controlled analgesia (PCA) during postoperative recovery as well as take-home medication. PURPOSE The objective of this study was to report on one institution's use of single bolus microdose intrathecal morphine (ITM) during PSF for AIS and its comparison to patients whose pain was controlled with PCA. STUDY DESIGN/SETTING Retrospective review. PATIENT SAMPLE AIS patients undergoing PSF from 2011–2019 were reviewed. PCA patients were included in Group 1 and ITM in Group 2. OUTCOME MEASURES Intraoperative clinical data (operative time, estimated blood loss), postoperative hospital stay course, request for prescription refill, morphine equivalence. METHODS In 2018, we instituted an RRP for scoliosis patients undergoing PSF utilizing intrathecal micro dose ITM. Previously, PCA was the mainstay for postop pain management. In the ITM protocol, patients receive 1.5 mcg/kg ITM diluted in 1 cc saline administered preoperatively by anesthesiologists or intraoperatively by the surgeon. Postoperatively, patients received IV ketorolac at 0.5mg/kg Q6h, PO Tylenol (15 mg/kg q6h), PO oxycodone (0.1 mg/kg q4), and IV hydromorphone (15 mcg/kg) for breakthrough pain. At discharge, PCA patients received 14-day prescriptions for 5mg oxycodone q6 compared to just 7-day prescriptions in the ITM group. Charts from 2011 – 2019 were reviewed. PCA patients were included in Group 1 and ITM in Group 2. Periop data and patient requests for prescription refills were analyzed and compared using Kruskal-Wallis and chi-squared tests. RESULTS A total of 340 patients (PCA: 215; ITM:125). Levels fused (p = 0.325) and BMI (p = 0.746) were similar. Patients in Group 1 had a significantly higher median length of stay (p CONCLUSIONS This is the first study showing that use of microdose ITM with oral analgesics have significantly better postoperative pain control and perioperative outcomes to PCA in the AIS population following PSF. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.