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Postoperative analgesia. Use of intrathecal morphine in children
J D Tobias1, J K Deshpande, R C Wetzel
1Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University Hospital, Baltimore, MD 21205.
Insights
Intrathecal morphine provides effective postoperative pain relief for children undergoing major surgery. Close monitoring for respiratory depression is essential for safe administration.
Area of Science:
- Anesthesiology
- Pediatric Surgery
- Pharmacology
Background:
- Opiate receptors in the spinal cord suggest potential for spinal analgesia.
- Intrathecal and epidural narcotics offer possibilities for postoperative pain management.
Purpose of the Study:
- To evaluate the safety and efficacy of intrathecal morphine for postoperative analgesia in children.
- To assess the duration of analgesia and need for supplemental pain relief.
Main Methods:
- Retrospective review of ten pediatric patients receiving intrathecal morphine.
- Dose administered: 0.02 mg/kg of preservative-free morphine (Duramorph).
- Administration via lumbar intrathecal injection before surgery.
Main Results:
- Adequate postoperative analgesia achieved in all ten children.
- No supplemental analgesics required for the first 15 postoperative hours.
- Surgical procedures included laparotomy, laryngotracheoplasty, and craniofacial reconstruction.
Conclusions:
- Intrathecal morphine is a safe and effective option for pediatric postoperative analgesia.
- Potential for delayed respiratory depression necessitates 24-hour monitoring, preferably in an ICU.
- This method is suitable for children undergoing major surgical procedures.
Abstract:
The identification of opiate receptors in the spinal cord gave rise to the suggestion that the use of intrathecal and epidural narcotics may provide effective and safe postoperative analgesia. The authors retrospectively reviewed the records of ten children who received intrathecal morphine as part of their anesthetic care over the last 2 years. Preservative-free morphine (Duramorph) in a dose of 0.02 mg/kg was administered to all patients in the lumbar intrathecal space before the start of the surgical procedure. Adequate postoperative analgesia was achieved in the ten children. No patient required supplemental analgesic agents for the initial 15-hour postoperative period. Surgical procedures included exploratory laparotomy, laryngotracheoplasty, and craniofacial reconstruction. As with narcotics administered by any route, intrathecal morphine can cause respiratory depression, and such depression may be delayed for up to 24 hours after the dose. Therefore, the postoperative respiratory status of these children should be monitored for 24 hours after the dose, preferably in an intensive care unit. With this caveat, the use of intrathecal morphine provides safe and effective postoperative analgesia in children undergoing major surgery.