Analgesic Safety and Efficacy of Intrathecal Morphine in Elective Posterior Lumbar Fusion: A Systematic Review With Meta-Analyses

Authors

Luke J. Weisbrod, University of Nebraska Medical CenterFollow
Jordan M. Rasmussen, University of Nebraska Medical CenterFollow
Cindy Schmidt, University of Nebraska Medical CenterFollow
Daniel L. Surdell, University of Nebraska Medical CenterFollow

Document Type

Literature Review (Systematic or Meta-Analysis)

Disciplines

Anesthesiology | Neurosurgery

Abstract

Background. We evaluated perioperative intrathecal morphine (ITM) compared with placebo or standard postoperative pain strategies in adults undergoing elective posterior lumbar fusion.

Methods. A systematic search of EMBASE, MEDLINE, the Cochrane Library, and Google Scholar (December 12, 2023) identified studies involving ITM in posterior lumbar fusion. Eligible patients were ≥18 years. Two reviewers extracted outcomes and assessed non-randomized studies with the Newcastle- Ottawa scale. Odds ratios (OR) and mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed- and random-effects models.

Results. Eleven studies met the inclusion criteria. ITM significantly lowered opioid requirements within 24 hours (MD -0.72, 95% CI [-1.30, -0.14], I² = 91.08%, p = 0.015) and pain scores at 24 hours (MD -0.57, 95% CI [-1.01, -0.13], I² = 73.17%, p = 0.010). Reductions were also seen in pain scores at 48 hours (MD -0.63, 95% CI [-1.55, 0.29], p = 0.178), hospital stay (MD -0.71, 95% CI [-1.77, 0.36], p = 0.191), sedation (OR -0.18, p = 0.594), and respiratory depression (OR -0.08, p = 0.782), though these were not statistically significant. ITM increased the incidence of pruritus (OR 1.04, 95% CI [0.45, 1.64], I² = 43.55%, p < 0.001), with non-significant rises in urinary retention (OR 0.45, p = 0.070) and nausea/vomiting (OR 0.03, p = 0.847).

Conclusion. Although based on relatively small and methodologically heterogeneous studies, these analyses suggest that perioperative ITM enhances analgesia and maintains an acceptable safety profile following posterior lumbar fusion.

DOI

https://doi.org/10.32873/unmc.dc.gmerj.7.2.007

Keywords

Posterior lumbar fusion, intrathecal morphine, arthrodesis, interbody, spine surgery

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Recommended Citation

Weisbrod, L. J., Rasmussen, J. M., Schmidt, C., , Surdell, D. L. Analgesic Safety and Efficacy of Intrathecal Morphine in Elective Posterior Lumbar Fusion: A Systematic Review With Meta-Analyses. Graduate Medical Education Research Journal. 2025 Dec 31; 7(2).
https://digitalcommons.unmc.edu/gmerj/vol7/iss2/7