Scoliosis
Conditions
Keywords
Pediatrics, Scoliosis, Morphine, Surgery, Analgesia
Brief summary
The purpose of this study is to examine if morphine administered by bolus before initiating Remifentanil by infusion decreases the incidence of acute post-operative opioid tolerance as demonstrated by decreased post - operative morphine consumption in children undergoing scoliosis surgery.
Detailed description
At our institution, a study has recently demonstrated that intraoperative infusion of remifentanil is associated with development of clinically relevant acute opioid tolerance in adolescents undergoing scoliosis surgery. This results in increased morphine consumption which in turn is associated with increased incidence of side effects such as respiratory depression, nausea and vomiting, pruritus, ileus and urinary retention. All of these side effects can result in increased consumption of rescue medications with the additional potential for increased duration of patient stay. Any measures that can be introduced to decrease the development of acute opioid tolerance in this patient population would have significant impact on patient morbidity, patient comfort and possibly duration of patient stay.
Interventions
DRUGMorphine
150 mcg/kg diluted in normal saline to a volume of 10 ml at time of induction of anesthesia
OTHERSaline
10 ml saline alone
Sponsors
The Hospital for Sick Children
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
11 Years to 18 Years
Healthy volunteers
No
Inclusion criteria
* Unpremedicated * ASA physical status 1 or 2 * Aged 11 - 18 * Scheduled to undergo posterior instrumentation for correction of idiopathic scoliosis
Exclusion criteria
* Chronic opioid use within three months prior to surgery * Inability to self-administer morphine using a patient-controlled analgesia (PCA) device * Elective postoperative ventilation * Obesity (\> 130% ideal body weight) * Known sensitivity to morphine, remifentanil or any other agent within the standardized protocol * Failure to obtain written consent or assent
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Morphine consumption | Every hour for four hours and then every four hours thereafter for 48 hours |
Secondary
| Measure | Time frame |
|---|---|
| Propofol and remifentanil consumption | 48 hours |
| Incidences of post-operative nausea, vomiting, pruritus and pyrexia | every hour for four hours and then every four hours thereafter for 48 hours |
Countries
Canada
Outcome results
None listed