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Efficacy and complications of morphine infusions in postoperative paediatric patients
Z Esmail1, C Montgomery, C Courtrn
1Department of Pharmacy, BC Research Institute for Child and Family Health, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Continuous intravenous morphine infusions for pediatric postoperative pain often led to inadequate pain relief and nausea/vomiting. Importantly, no cases of respiratory depression were observed in this study.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacovigilance
Background:
- Acute postoperative pain in children requires effective management.
- Continuous intravenous morphine infusions are utilized for pediatric pain control.
- Understanding adverse drug reactions (ADRs) is crucial for optimizing pediatric pain therapy.
Purpose of the Study:
- To assess the efficacy of continuous intravenous morphine infusions for acute postoperative pain in pediatric patients.
- To determine the incidence of clinically significant adverse drug reactions (ADRs) associated with these infusions.
- To identify common ADRs and evaluate the rate of inadequate analgesia.
Main Methods:
- A retrospective study was conducted on 110 pediatric patients (3 months to 16.7 years).
- Data on pain management and ADRs were collected for up to 72 hours post-infusion initiation.
- Specific definitions for ADRs were established prior to data collection.
Main Results:
- Inadequate analgesia was reported in 65.5% of patients within the first 24 hours, particularly with lower infusion rates (≤20 mcg/kg/h).
- Nausea/vomiting was the most frequent ADR (42.5%).
- No instances of respiratory depression were recorded (95% CI: 0-3.3%). Other ADRs included urinary retention (13.5%) and pruritus (12.7%).
Conclusions:
- Continuous intravenous morphine infusions are associated with a high rate of inadequate analgesia and common ADRs like nausea/vomiting in pediatric patients.
- The absence of respiratory depression suggests a potentially favorable safety profile regarding this critical ADR.
- Further research is needed to optimize morphine infusion strategies to improve analgesia and manage side effects effectively.
Abstract:
The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients >/=5 three months of age (0.3-16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 microg.kg-1.h-1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0-3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.