Abstract
Purpose
To compare two doses of bolus epidural morphine with bolus iv morphine for postoperative pain after abdominal or genitourinary surgery in infants.
Methods
Eighteen infants were randomly assigned to bolus epidural morphine (0.025 mg · kg−1 or 0.050 mg · kg−1) or bolus iv morphine (0.050–0.150 mg · kg−1). Postoperative pain was assessed and analgesia provided, using a modified infant pain scale. Monitoring included continuous ECG, pulse oximetry, impedance and nasal thermistor pneumography. The CO2 response curves and serum morphine concentrations were measured postoperatively.
Results
Postoperative analgesia was provided within five minutes by all treatment methods. Epidural groups required fewer morphine doses (3.8 ± 0.8 for low dose [LE], 3.5 ± 0.8 for high dose epidural [HE] vs. 6.7 ± 1.6 for iv, P < 0.05) and less total morphine (0.11 ± 0.04 mg · kg−1 for LE, 0.16 ± 0.04 for HE vs 0.67 ± 0.34 for iv, P < 0.05) on POD1 Dose changes were necessary in all groups for satisfactory pain scores. Pruritus, apnoea, and haemoglobin desaturation occurred in all groups. CO2 response curve slopes, similar preoperatively (range 36–41 ml · min−1 · mmHg ETco −12 · kg−1) were generally depressed (range, 16–27 ml · min−1 · mmHg ETco −12 · kg−1) on POD1. Serum morphine concentrations, negligible in LE (<2 ng · ml−1), were similar in the HE and iv groups (peak 8.5 ± 12.5 and 8.6 ± 2.4 ng · ml−1, respectively).
Conclusion
Epidural and iv morphine provide infants effective postoperative analgesia, although side effects are common. Epidural morphine gives satisfactory analgesia with fewer doses (less total morphine); epidural morphine 0.025 mg · kg−1 is appropriate initially. Infants receiving epidural or iv morphine analgesia postoperatively need close observation in hospital with continuous pulse oximetry.
Résumé
Objectif
Comparer deux doses épidurales de morphine en bolus avec un bolus de morphine iv administrées pour la douleur postopératoire après une chirurgie abdominale ou urogénitale chez l’enfant.
Méthodes
Dix-huit enfants ont été répartis pour recevoir soit un bolus de morphine épidural (0,025 mg · kg−1 ou 0,05 mg · kg−1) soit un bolus de morphine iv (0,050–0,150 mg · kg−1). La douleur postopératoire était évaluée et l’analgésie pourvue sur la basé d’une échelle de douleur modifée pour la pédiatrie. Le monitorage incluait l’ECG continu, l’oxymétrie de pouls, la pneumographie par impédance avec un thermistor nasal. En postopératoire, on mesurait les courbes de réponse au CO2 et les concentrations sériques de morphine.
Résultats
L’analgésie postopératoire survenait en déçà de cinq minutes, indépendamment du traitement administré. Un nombre inférieur de doses de morphine (3,8 ± 0,8 pour la dose légère [DL], 3,5 ± 0,8 pour la dose forte [DF] vs 6,7 ± 1,6 pour la morphine iv, P < 0,05) à demande a été requis pour les groupes recevant la morphine épidurale. Pour obtenir des scores satisfaisants sur l’échelle de la douleur, on a dû modifier les doses dans tous les groupes. On a noté du prurit, de l’apnée et une désaturation en oxygène dans tous les groupes. Les courbes identiques en préopératoire de la réponse au CO2 (écart, 36–41 ml · min−1 · mmHg ETco −12 · kg−1) étaient généralement déprimées (écart, 16–27 ml · min−1 · mmHg ETco −12 · kg−1). Les concentrations de morphine sérique, négligeables pour DL (<2 ng · ml−1), étaient identiques pour DF et iv (maximum respectif 8,5 ± 12,5 et 8,6 ± 1,4 ng · ml−1).
Conclusion
La morphine épidurale et la morphine iv procurent une analgésie postopératoire suffisante aux enfant malgré des effets secondaires fréquents. La morphine épidurale a produit une analgésie satisfaisante nécessitant moins de doses (dose totale moindre); la morphine épidurale 0,025 mg · kg−1 est appropriée au début. Les enfants qui reçoivent de la morphine épidurale ou iv comme analgésique postopératoire doivent être surveillés de près à l’hôpital avec l’oxymétrie de pouls en continu.
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Supported by BRSG Grant #RR05655-20.
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Haberkern, C.M., Lynn, A.M., Geiduschek, J.M. et al. Epidural and intravenous bolus morphine for postoperative analgesia in infants. Can J Anaesth 43, 1203–1210 (1996). https://doi.org/10.1007/BF03013425
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DOI: https://doi.org/10.1007/BF03013425