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Single-dose caudal epidural morphine in children: safe, effective, and easy
1Department of Anesthesiology, Phoenix Children's Hospital, AZ.
Study Objective:
To determine whether a single epidural dose of morphine sulfate is effective in providing 12- to 24-hour pain relief in children.
Design:
A chart review of 113 consecutive pediatric patients having received a single dose of epidural morphine.
Setting:
An inpatient anesthesia and surgical service at a regional children's hospital.
Patients:
One hundred thirteen consecutive pediatric patients from 2 months to 15 years old who underwent major orthopedic, thoracic, genitourinary, or abdominal surgical procedures.
Interventions:
60 micrograms/kg of preservative-free morphine sulfate was administered epidurally after induction of anesthesia but before surgery began. The epidural space was accessed caudally, and a total volume of 1 ml/kg to a maximum of 20 ml was injected. No other intraoperative opioids were administered.
Measurements And Main Results:
Forty-seven percent of the patients required no parenteral analgesic for 12 hours after receiving a single dose of epidural morphine, and only 10% required more than 0.1 mg/kg of parenteral morphine during this 12-hour period. For infants younger than 1 year of age, the supplemental intravenous (IV) morphine requirement was almost identical to that of the entire study population. There was no respiratory depression. All patients except those who had thoracotomies were followed on regular pediatric nursing floors.
Conclusions:
Single-dose caudal epidural morphine in children is safe and effective when administered intraoperatively prior to surgery as the only opioid and coupled with appropriate monitoring, nursing education, and follow-up by the anesthesiologist. These patients can be followed on regular nursing floors with proper monitoring.