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Published on: July 29, 2014
Intrathecal morphine provides effective and safe analgesia in children after cardiac surgery
P K Suominen1, P G Ragg, D F McKinley
1Department of Anesthesia and Pain Management, Royal Children's Hospital, Parkville, Melbourne, Victoria, Australia. pertti.suominen@hus.fi
Insights
Intrathecal morphine (ITM) at 20 micrograms/kg significantly reduced intravenous morphine use in children after heart surgery. This analgesic approach provided effective pain control for approximately 12 hours post-operatively.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Cardiac Surgery
Background:
- Post-operative pain management in children undergoing cardiac surgery is critical.
- Sternotomy incisions in pediatric cardiac surgery necessitate effective analgesia.
- Intrathecal morphine (ITM) is a potential option for post-operative pain control.
Purpose of the Study:
- To evaluate the analgesic efficacy of intrathecal morphine (ITM) in pediatric patients after cardiac surgery.
- To assess the safety profile of ITM in this patient population.
- To determine the opioid-sparing effect of ITM compared to standard care.
Main Methods:
- A prospective, randomized, observer-blinded study involving 80 children (3-55 kg) undergoing elective cardiac surgery.
- Two groups: one receiving 20 micrograms/kg ITM at anesthesia induction, the other serving as a control.
- Standardized post-operative intravenous morphine administration guided by the Cardiac Analgesic Assessment Scale (CAAS).
Main Results:
- The ITM group experienced a significantly longer time to first intravenous morphine dose (12.3 vs. 8.7 hours) and to start of IV morphine post-PICU admission (6.0 vs. 3.4 hours).
- Total intravenous morphine consumption was significantly lower in the ITM group over 19 post-operative hours (P=0.03).
- No significant differences were observed in extubation time or PICU discharge duration; adverse events were infrequent in both groups.
Conclusions:
- A 20 micrograms/kg dose of ITM demonstrated a significant intravenous morphine-sparing effect in pediatric cardiac surgery patients.
- Effective analgesia was achieved for approximately 12 hours following ITM administration.
- ITM is a safe and effective option for post-operative pain management in this cohort.
Background:
The purpose of this prospective, randomized, blinded to observer study was to assess the analgesic effect and safety of intrathecal morphine (ITM) in post-operative pain control in children after heart surgery with a sternotomy incision.
Methods:
Eighty children, 3-55 kg in body weight, undergoing elective cardiac surgery with opioid-based anaesthesia were randomly divided into two treatment groups to receive either 20 micrograms/kg ITM at induction of anaesthesia or control. To standardize the protocol for administration of post-operative rescue intravenous morphine boluses and infusion (20-60 micrograms/kg/h), the Cardiac Analgesic Assessment Scale (CAAS) was used.
Results:
Nine patients were excluded from the study after randomization. Thirty-five patients were enrolled to the ITM group and 36 to the control group. The groups were similar for demographics and intra-operative clinical characteristics. The mean time for the first intravenous morphine dose from ITM administration or equivalent time zero in the control group was significantly longer (P = 0.003) in the ITM group compared with the control group (12.3 vs. 8.7 h). Time from Paediatric Intensive Care Unit (PICU) admission to the start of intravenous morphine was also significantly longer (P = 0.01) in the ITM group (6.0 vs. 3.4 h). The total intravenous morphine consumption over the mean 19 post-operative hours was significantly lower (P = 0.03) in the ITM group. However, the use of ITM did not result in earlier extubation or earlier discharge from the PICU. Of the 35 patients who received ITM at induction of anesthesia, 20% (n = 7) did not require any additional morphine in the PICU compared with three out of 36 control group patients. This did not reach statistical significance. The incidence of adverse events was low in both groups.
Conclusions:
An ITM dose of 20 micrograms/kg had a significant (P = 0.03) intravenous morphine-sparing effect after cardiac surgery. Effective analgesia was observed for 12 h after administration of intrathecal morphine.
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