scholarly journals Intrathecal morphine in lumbar spine surgery: a novel injection technique

2015 ◽  
Vol 42 (S1) ◽  
pp. S49-S50
Author(s):  
GA Jewett ◽  
D Yavin ◽  
P Dhaliwal ◽  
T Whittaker ◽  
J Krupa ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Dural Puncture ◽  
Intrathecal Morphine ◽  
Lumbar Fusion ◽  
Standard Of Care ◽  
Csf Leak ◽  
Lumbar Spine Surgery ◽  
Injection Technique ◽  
Csf Leakage

Background: Intrathecal morphine (ITM) is an efficacious method of providing post-operative analgesia. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. This may in part be attributed to concerns over precipitating a cerebrospinal fluid (CSF) leak following dural puncture. Methods: The dural sac is penetrated obliquely at a 30° angle to prevent overlap of dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60° bend to a standard 30-gauge needle. Participating spinal surgeons were provided with brief instructions outlining the injection technique. Adherence and complications were collected prospectively. Results: The technique was applied to 98 cases of elective lumbar fusion at our institution. Two cases (2.0%) of non-adherence followed pre-injection dural tear. 96 cases of oblique ITM injection resulted in no attributable instances of post-operative CSF leakage. Two cases (2.1%) of transient, self-limited CSF leakage immediately following ITM injection were observed without associated sequelae or requirement for further intervention. Conclusions: Oblique dural puncture is not associated with increased incidence of post-operative CSF leakage. This safe and reliable method of delivery of ITM should be routinely considered in lumbar spine surgery.

scholarly journals Oblique Intrathecal Injection in Lumbar Spine Surgery: A Technical Note

2017 ◽  
Vol 44 (5) ◽  
pp. 514-517
Author(s):  
Gordon A.E. Jewett ◽  
Daniel Yavin ◽  
Perry Dhaliwal ◽  
Tara Whittaker ◽  
JoyAnne Krupa ◽  
...  
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Intrathecal Morphine ◽  
Single Case ◽  
Controlled Trial ◽  
Intrathecal Injection ◽  
Technical Note ◽  
Csf Leak ◽  
Lumbar Spine Surgery ◽  
Csf Leakage

AbstractObjectives: Intrathecal morphine (ITM) is an efficacious method of providing postoperative analgesia and reducing pain associated complications. Despite adoption in many surgical fields, ITM has yet to become a standard of care in lumbar spine surgery. Spine surgeons’ reticence to make use of the technique may in part be attributed to concerns of precipitating a cerebrospinal fluid (CSF) leak. Methods: Herein we describe a method for oblique intrathecal injection during lumbar spine surgery to minimize risk of CSF leak. The dural sac is penetrated obliquely at a 30° angle to offset dural and arachnoid puncture sites. Oblique injection in instances of limited dural exposure is made possible by introducing a 60° bend to a standard 30-gauge needle. Results: The technique was applied for injection of ITM or placebo in 104 cases of lumbar surgery in the setting of a randomized controlled trial. Injection was not performed in two cases (2/104, 1.9%) following preinjection dural tear. In the remaining 102 cases no instances of postoperative CSF leakage attributable to oblique intrathecal injection occurred. Three cases (3/102, 2.9%) of transient CSF leakage were observed immediately following intrathecal injection with no associated sequelae or requirement for postsurgical intervention. In two cases, the observed leak was repaired by sealing with fibrin glue, whereas in a single case the leak was self-limited requiring no intervention. Conclusions: Oblique dural puncture was not associated with increased incidence of postoperative CSF leakage. This safe and reliable method of delivery of ITM should therefore be routinely considered in lumbar spine surgery.

scholarly journals Continuous Spinal Analgesia after Extensive Lumbar Spine Surgery

2009 ◽  
Vol 37 (3) ◽  
pp. 473-476
Author(s):  
A. Mckenzie ◽  
M. Sherwood
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Spinal Surgery ◽  
Dural Puncture ◽  
Lumbar Spine Surgery ◽  
Spinal Analgesia ◽  
Post Dural Puncture Headache ◽  
Drug Doses ◽  
Spinal Catheter

A 77-year-old male underwent L-1 to S-1 spine decompression and fusion from L-3 to S-1. A 25 G spinal catheter was placed intraoperatively and bupivacaine 1.25 mg/ml, fentanyl 2 μg/ml and morphine 3 μg/ml infused. The patient was pain-free for the duration of the infusion. Continuous spinal analgesia was effective after extensive spinal surgery. The risks of post-dural puncture headache, infection of wound and/or meninges and the optimum drug doses and combinations are yet to be quantified in this setting.

scholarly journals Is a Single Low Dose of Intrathecal Morphine a Useful Adjunct to Patient-Controlled Analgesia for Postoperative Pain Control Following Lumbar Spine Surgery? A Preliminary Report

2015 ◽  
Vol 20 (3) ◽  
pp. 129-132 ◽  
Author(s):  
David Yen ◽  
Kim Turner ◽  
David Mark
Keyword(s):  
Lumbar Spine ◽  
Postoperative Pain ◽  
Respiratory Depression ◽  
Spine Surgery ◽  
Pain Control ◽  
Low Dose ◽  
Intrathecal Morphine ◽  
Lumbar Spine Surgery ◽  
Patient Controlled Analgesia ◽  
Postoperative Pain Control

BACKGROUND: Several studies addressing intrathecal morphine (ITM) use following spine surgery have been published either involving the pediatric population, using mid- to high-dose ITM, or not in conjunction with morphine patient-controlled analgesia (PCA).OBJECTIVES: To determine whether low-dose ITM is a useful adjunct to PCA for postoperative pain control following elective lumbar spine surgery in adults.METHODS: Thirty-two patients were enrolled in a double-blinded randomized controlled trial, and received either ITM or intrathecal placebo. Postoperatively, all patients were given a PCA pump and observed for the first 24 h in a step-down unit. Measurements of: total PCA morphine consumed in the first 24 h; intensity of pain; pruritus; nausea at 4 h, 8 h and 24 h; time to first ambulation; length of hospital stay; and occurrences of respiratory depression were recorded.RESULTS: The total PCA use was significantly lower in the ITM group. There were lower average pain scores in the ITM group, which increased to that of the intrathecal placebo group over 24 h; however, this failed to attain statistical significance. There were no differences in nausea, pruritus, time to first ambulation or hospital length stay. There were no cases of respiratory depression in either group.CONCLUSIONS: ITM may be a useful adjunct to PCA, but did not decrease time to ambulation or length of stay.

scholarly journals Delayed Ejaculation After Lumbar Spine Surgery: A Claims Database Analysis

2020 ◽  
pp. 219256822096243
Author(s):  
Hriday P. Bhambhvani ◽  
Alex M. Kasman ◽  
Chiyuan A. Zhang ◽  
Serena S. Hu ◽  
Michael L. Eisenberg
Keyword(s):  
Lumbar Spine ◽  
Spine Surgery ◽  
Interbody Fusion ◽  
Lumbar Fusion ◽  
Multivariable Analysis ◽  
Thoracolumbar Spine ◽  
Lumbar Spine Surgery ◽  
Lumbar Interbody Fusion ◽  
Delayed Ejaculation ◽  
Institutional Experience

Study Design: Retrospective cohort. Objectives: Delayed ejaculation (DE) is a distressing condition characterized by a notable delay in ejaculation or complete inability to achieve ejaculation, and there are no existing reports of DE following lumbar spine surgery. Inspired by our institutional experience, we sought to assess national rates of DE following surgery of the lumbar spine. Methods: We queried the Optum De-identified Clinformatics Database for adult men undergoing surgery of the lumbar spine between 2003 and 2017. The primary outcome was the development of DE within 2 years of surgery. Multivariable logistic regression was performed to identify factors associated with the development of DE. Results: We identified 117 918 men who underwent 162 646 lumbar spine surgeries, including anterior lumbar interbody fusion (ALIF), posterior lumbar fusion (PLF), and more. The overall incidence of DE was 0.09%, with the highest rate among ALIF surgeries at 0.13%. In multivariable analysis, the odds of developing DE did not vary between anterior/lateral lumbar interbody fusion, PLF, and other spine surgeries. A history of tobacco smoking (OR = 1.47, 95% CI 1.00-2.16, P = .05) and obesity (OR = 1.56, 95% CI 1.00-2.44, P = .05) were associated with development of DE. Conclusions: DE is a rare but distressing complication of thoracolumbar spine surgery, and patients should be queried for relevant symptoms at postoperative visits when indicated.

Use of intrathecal morphine for postoperative pain relief following lumbar spine surgery

1985 ◽  
Vol 63 (3) ◽  
pp. 413-416 ◽  
Author(s):  
Padraic O'Neill ◽  
Christine Knickenberg ◽  
Senarath Bogahalanda ◽  
Anthony E. Booth
Keyword(s):  
Lumbar Spine ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Spine Surgery ◽  
Intrathecal Morphine ◽  
Postoperative Pain Relief ◽  
Lumbar Spine Surgery ◽  
Double Blind ◽  
Content Type ◽  
The Mean

✓ A randomized prospective double-blind trial of intrathecal morphine for postoperative pain relief following lumbar spine surgery is described. Intrathecal morphine significantly reduced the mean pain score in the postoperative period (p < 0.01) and there was a corresponding significant reduction in the need for additional postoperative analgesia (p < 0.05). The possible mechanism of action of intrathecal morphine and the potential advantages of this technique are discussed. Possible side effects are also considered, and caution is urged until wider experience has been obtained.

scholarly journals Neurologic Disease Is a Risk Factor for Revision After Lumbar Spine Fusion

2019 ◽  
Vol 9 (6) ◽  
pp. 630-634 ◽  
Author(s):  
Steven D. Glassman ◽  
Leah Y. Carreon ◽  
John R. Dimar ◽  
Jeffrey L. Gum ◽  
Mladen Djurasovic
Keyword(s):  
Risk Factor ◽  
Lumbar Spine ◽  
Spine Surgery ◽  
Cox Regression ◽  
Revision Rate ◽  
Lumbar Fusion ◽  
Lumbar Spine Surgery ◽  
Neurologic Disorder ◽  
Cox Regression Analysis ◽  
Neurologic Disorders

Study Design: Medicare database analysis. Objective: The purpose of this study was to investigate whether neurologic disorders represent a risk factor for revision after lumbar spine surgery. Methods: Patients who underwent lumbar spine surgery were identified from 5% Medicare Part B claims between 2005 and 2008. Cox regression analysis was used to evaluate risk factors for revision within the 7 years after the index lumbar surgery. Covariates included age, gender, race, census region, Medicare buy-in status, Charlson score, year, prior lumbar fusion within 2 years of index surgery, prior diagnosis of cervical spondylotic myelopathy treated with or without cervical spine surgery, and diagnoses of other neuromuscular conditions. Results: Of 8665 cases who had decompression only, 401 (5%) had a revision within 7 years after the index surgery. Factors predictive of revision were prior lumbar fusion (hazard ratio [HR] = 2.78, confidence interval [CI] = 1.43-5.37, P = .002) and being female (HR = 1.61, CI = 1.31-1.97, P < .001). Of 5501 cases who had a decompression and fusion, 752 (14%) had a revision surgery within 7 years after the index surgery. Factors predictive of revision were the presence of a neurologic disorder (HR = 1.24, CI = 1.05-1.46, P = .010), prior lumbar fusion (HR = 3.09, CI = 2.05-4.63, P < .001), and being female (HR = 1.35, CI = 1.15-1.57, P < .001). Conclusions: An increase in revision rate ( P = 0.01, HR = 1.24) was seen in patients with neurologic disorders undergoing lumbar decompression and fusion, although not for patients undergoing decompression alone. This suggests an opportunity to improve clinical outcome and reduce revision rate through improved surgical decision making or treatment of the neurologic disorder.

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