• Perry Dhaliwal, Daniel Yavin, Tara Whittaker, Geoffrey S Hawboldt, Gordon A E Jewett, Steven Casha, and Stephan du Plessis.
• Section of Neurosurgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.
• Neurosurgery. 2019 Aug 1; 85 (2): 189-198.

BackgroundDespite the potential for faster postoperative recovery and the ease of direct intraoperative injection, intrathecal morphine is rarely provided in lumbar spine surgery.ObjectiveTo evaluate the safety and efficacy of intrathecal morphine following lumbar fusion.MethodsWe randomly assigned 150 patients undergoing elective instrumented lumbar fusion to receive a single intrathecal injection of morphine (0.2 mg) or placebo (normal saline) immediately prior to wound closure. The primary outcome was pain on the visual-analogue scale during the first 24 h after surgery. Secondary outcomes included respiratory depression, treatment-related side effects, postoperative opioid requirements, and length of hospital stay. An intention-to-treat, repeated-measures analysis was used to estimate outcomes according to treatment in the primary analysis.ResultsThe baseline characteristics of the 2 groups were similar. Intrathecal morphine reduced pain both at rest (32% area under the curves [AUCs] difference, P < .01) and with movement (22% AUCs difference, P < .02) during the initial 24 h after surgery. The risk of respiratory depression was not increased by intrathecal morphine (hazard ratio, 0.86; 95% confidence interval, 0.44 to 1.68; P = .66). Although postoperative opioid requirements were reduced with intrathecal morphine (P < .03), lengths of hospital stay were similar (P = .32). Other than a trend towards increased intermittent catheterization among patients assigned to intrathecal morphine (P = .09), treatment-related side effects did not significantly differ. The early benefits of intrathecal morphine on postoperative pain were no longer apparent after 48 h.ConclusionA single intrathecal injection of 0.2 mg of morphine safely reduces postoperative pain following lumbar fusion.Copyright © 2018 by the Congress of Neurological Surgeons.

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