# Comparative effectiveness of intrathecal morphine versus erector spinae plane block for analgesia after scoliosis surgery: a retrospective analysis

## TL;DR

This study found that intrathecal morphine significantly reduces opioid use and improves pain control after scoliosis surgery compared to other techniques.

## Contribution

The study provides evidence that intrathecal morphine is more effective than erector spinae plane block for post-scoliosis analgesia.

## Key findings

- Intrathecal morphine significantly reduced morphine consumption at 24, 48, and 72 hours post-surgery.
- Intrathecal morphine improved pain scores by more than 2 points within the first 24 hours.
- Erector spinae plane block showed no additional analgesic benefit when combined with intrathecal morphine.

## Abstract

To compare the efficacy of analgesia techniques after idiopathic scoliosis surgery.

Register data of scoliosis patients were analyzed between January 2020 and June 2023. Patients were divided into four groups: intravenous anesthesia (IA) only, Erector Spinae Plane Block (ESPB), Intra-Thecal Morphine (ITM) and association of ESPB + ITM. The primary outcome measure was morphine consumption median [interquartile range] at 24 h postoperatively. We also investigated morphine consumption at 48 and 72 h, pain scores, co-analgesic drugs, and specific complications: respiratory, cardiovascular, post-lumbar puncture syndrome.

Among 119 patients, 52 (43.7%) received IA, 32 ESPB (26.9%), 9 ITM (7.6%) and 26 (21.8%) ITM + ESPB. Morphine consumption at 24 h was significantly (p < 0.001) reduced for patients with ITM: IA 51 mg (38–71), ESPB 46 mg (30–70), ITM 12 mg (7–29), ITM + ESPB 20 mg (10–28). This superior effect of ITM was sustained until 72 h for morphine consumption and pain scores. Compared to other techniques, the visual analog scale for pain assessment revealed a significant (p < 0.001) reduction by more than 2 points when using ITM within the first 24 postoperative hours, and lower median sufentanil doses were required during anesthesia. No postoperative complications occurred.

In this retrospective cohort, ITM was associated with significantly reduced opioid use and improved pain scores. ESPB did not show a significant additive effect. These findings should be interpreted with caution due to the retrospective design and potential selection bias. Prospective randomized trials are needed to confirm these results.

3 - Retrospective study.

•Intrathecal morphine (100 μg) significantly improves early postoperative pain control and reduces opioid consumption.•Low-dose intrathecal morphine showed a strong safety profile with no adverse events such as respiratory depression.•In this study Erector Spinae Plane Block (ESPB) showed no additional analgesic benefit when combined with intrathecal morphine.•Intrathecal morphine is a key option for Enhanced Recovery After Surgery (ERAS) protocols in scoliosis surgery.

Intrathecal morphine (100 μg) significantly improves early postoperative pain control and reduces opioid consumption.

Low-dose intrathecal morphine showed a strong safety profile with no adverse events such as respiratory depression.

In this study Erector Spinae Plane Block (ESPB) showed no additional analgesic benefit when combined with intrathecal morphine.

Intrathecal morphine is a key option for Enhanced Recovery After Surgery (ERAS) protocols in scoliosis surgery.