OP035 Intrathecal morphine as a strategy to eliminate IVPCA for the management of post-surgical pain in scoliosis patients
Bibliographic record
Abstract
Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission Background and Aims Surgical correction of adolescent idiopathic scoliosis (AIS) requires high doses of opioids, traditionally via intravenous patient-controlled analgesia (IVPCA). An ERAS protocol was implemented at our institution to stop routine use of IVPCA, to be replaced with either intrathecal morphine injection or enteral methadone, and transition to enteral analgesia by morning after surgery. Methods With REB approval, chart review was conducted of all patients who underwent surgical correction for AIS before and after protocol implementation, to compare outcomes and feasibility of managing pain with the ERAS protocol. Results 62 patients were included, 32 receiving IVPCA and 30 in the ERAS pathway. No significant difference between groups by age, gender or BMI. Majority of patients in the ERAS pathway did not require rescue doses of opioids in the recovery room (53.3%), POD 0 (76.7%) or POD 1 (73.3%). There were statistically significant differences in pain scores between the two groups, with the IVPCA group having higher pain scores at 0 hours (p=0.002), ERAS group having higher pain scores at 24 hours (p=0.02) and 36 hours (0.01), with no difference in pain scores between groups at 12 hours (p=0.12). Length of stay in ERAS pathway (mean 3.16 days) versus IVPCA (2.83 days) pathway were not statistically significantly different (p=0.07). Conclusions Analgesia after AIS repair can be successfully achieved without IVPCA, with intrathecal morphine or methadone, to allow for increased mobility, reduced use of resources and decreased reliance on intravenous medications. More judicious use of enteral rescue doses should be incorporated to further improve pain management.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".