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Morphine infusions after pediatric cranial surgery: a retrospective analysis of safety and efficacy

Christine H K Ou1, Sarah K Kent, Amy M Hammond

  • 1Neurosciences & Surgery Unit, British Columbia Children's Hospital. cou@cw.bc.ca

Canadian Journal of Neuroscience Nursing
|October 17, 2008
PubMed

Insights

Continuous morphine infusion (CMI) offers comparable pain control to acetaminophen and codeine for pediatric patients after cranial surgery. This study found CMI to be a safe alternative, with careful nursing observation ensuring patient safety on surgical units.

Area of Science:

  • Pediatric Anesthesiology
  • Neurocritical Care
  • Pain Management

Background:

  • Morphine infusions are often avoided post-pediatric cranial surgery due to concerns about masking neurological changes.
  • Despite this, a significant percentage of children experience moderate to severe pain after craniotomies.
  • Codeine phosphate is frequently the preferred analgesic, though morphine's efficacy in acute pain is established.

Purpose of the Study:

  • To evaluate the efficacy and safety of intravenous morphine infusions outside the intensive care unit (ICU) for children undergoing cranial surgery.
  • To compare continuous morphine infusion (CMI) with acetaminophen and codeine for postoperative pain management in this population.

Main Methods:

  • Retrospective case series analysis of 71 children's medical records.
  • Patients underwent cranial reconstruction or supratentorial/infratentorial craniotomies.
  • Comparison of pain control and adverse events between CMI and acetaminophen/codeine groups.

Main Results:

  • No statistical difference in pain control was observed between the CMI and acetaminophen/codeine groups.
  • A statistically significant increase in nausea was noted on postoperative day one in the CMI group (p = 0.002).
  • 37 children received CMI, while 34 received acetaminophen and codeine.

Conclusions:

  • Continuous morphine infusion (CMI) is a safe and effective treatment option for pediatric patients after cranial surgery, comparable to acetaminophen and codeine.
  • Careful nursing observation allows for the safe administration of CMI in a non-ICU surgical unit setting.
  • These findings support reconsidering the avoidance of morphine infusions in this patient population.
Abstract

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