AN EVALUATION OF POST-SURGICAL PAIN MANAGEMENT: ORAL-ONLY MORPHINE VERSUS COMBINED ORAL AND INTRAVENOUS PATIENT-CONTROLLED ANALGESIA IN SCOLIOSIS PATIENTS

Post-operative pain related to posterior spinal fusion (PSF) poses a barrier to patient recovery. Intravenous patient-controlled analgesia (IV PCA) is a common treatment for acute pain after surgery. However, this technique limits patient mobility and demands considerable resources from medical staff. Conversely, oral opioids have shown to be a safe, non-invasive alternative with a lower risk of infection, improved post-operative mobility and a reduced treatment cost. For the last five years, we have followed an enhanced recovery after surgery protocol (ERAS) emphasizing early mobilization and urinary catheter removal, routine use of intrathecal morphine and the use of non-steroidal anti-inflammatory drugs. With that being said, one of the ERAS principles is constant audit of current practices which is why we're exploring alternative pain management strategies. Therefore, this study evaluates differences in treatment outcomes between patients who received combined oral and IV PCA and oral-only analgesics. This is a retrospective cohort study of 39 adolescent idiopathic scoliosis (AIS) patients who underwent PSF surgery at a single institution by one physician between January 2022 to June 2023. All the patients were treated with ERAS, and divided into those who received a combination of oral and IV PCA or oral-only opioids postoperatively. Demographic, treatment outcomes as well as post-surgical morphine consumption and pain at key time points were documented. Independent samples t-tests and chi-squares were used to assess group differences for treatment and pre and postoperative patient-reported outcomes. Twenty-five patients receiving a combination of IV PCA-oral and 14 receiving oral-only analgesics were evaluated. IV PCA-oral combined and the oral-only group showed no differences with respect to female sex, age at surgery, pre-and postoperative Cobb angle, % Cobb angle correction and the number of intervertebral levels fused as shown in Table 1. Oral-only patients had a significantly shorter length of stay than those who received IV PCA-oral combined (52.9±9.3 versus 70±33.5 hours, p=0.023). Morphine consumption was significantly reduced at 0-12 hours (p To sum up, study findings suggest that oral-only analgesics can lead to a shorter hospital stay, lower morphine consumption in the initial postoperative hours, and similar pain outcomes in most cases. This further enhances the potential for oral-only analgesics in an ERAS protocol, to be used as a safe and efficient strategy for pain management, promoting earlier mobility while reducing the risks of complications and costs often associated with IV. For any figures or tables, please contact the authors directly.