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

Abstract

BACKGROUND CONTEXT Narcotic substance addiction has been on a rise across all patient populations. Narcotics are often given in the form of patient controlled analgesic (PCA) during postoperative hospital stay as well as take-home medication. PURPOSE The objective of this study was to report on one institution's use of intrathecal single micro-dose duramorph during surgery and its comparison to patients that had undergone traditional PCA. STUDY DESIGN/SETTING Prospective study. PATIENT SAMPLE A total of 270 patients (209 PCA; 61 Duramorph). OUTCOME MEASURES Pain score, levels fused, Cobb angle, length of stay, refills, surgical time, anesthesia time, cardiac complications, respiratory complications, days to ambulation, days to first meal, transfusion rate. METHODS In 2018, we instituted RRP for scoliosis patients undergoing PSF utilizing intrathecal micro dose duramorph. PCA used to be the mainstay for postop pain management. In the duramorph protocol, patients receive 1mcg/kg intraspinal morphine diluted in 1 cc saline administered preop by anesthesiologists or intraop by surgeon. AIS patients undergoing PSF from 2011 – 2018 were reviewed. PCA patients were included in Group 1(G1) and Duramorph in Group 2(G2). Periop data were analyzed. Fisher's exact test and Wilcoxon tests were utilized. RESULTS A total of 270 patients (PCA: 209;Duramorph:61). Median Cobb in G1 was 54° and 50° in G2(p CONCLUSIONS Using single use micro-dose Duramorph can eliminate the need for PCA with similar postoperative outcomes in a RRP. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.