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The dose response of caudal morphine in children
E J Krane1, D C Tyler, L E Jacobson
1Department of Anesthesiology, University of Washington School of Medicine, Seattle.
Insights
This study found that higher doses of caudal epidural morphine provide longer pain relief in children after surgery. Researchers recommend a 0.033 mg/kg dose as a starting point for pediatric analgesia.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Effective postoperative pain management is crucial for pediatric surgical recovery.
- Caudal epidural analgesia is a common technique for infra-diaphragmatic surgery in children.
- Optimizing morphine dosage for caudal epidural administration requires further investigation.
Purpose of the Study:
- To compare the duration of analgesia and incidence of side effects for three different doses of caudal epidural morphine in pediatric patients.
- To determine the optimal initial dose of caudal epidural morphine for prolonged analgesia in children.
Main Methods:
- A randomized study involving 32 children (aged 1.2-7.9 years) receiving caudal epidural morphine at doses of 0.033, 0.067, or 0.10 mg/kg.
- Lidocaine was used to confirm correct catheter placement.
- Pain scores and time to pain recurrence were assessed to determine analgesia duration.
Main Results:
- The 0.10 mg/kg dose provided significantly longer analgesia (13.3 ± 4.7 hours) compared to 0.033 mg/kg (10.0 ± 3.3 hours) and 0.067 mg/kg (10.4 ± 4.2 hours).
- Vomiting, pruritus, and urinary retention frequencies were similar across groups.
- Vomiting was less frequent in patients with nasogastric drainage.
- One case of delayed respiratory depression occurred with the highest dose.
Conclusions:
- Caudal epidural morphine, within the tested dosage range (0.033-0.10 mg/kg), effectively provides prolonged analgesia in children.
- The authors suggest 0.033 mg/kg as a recommended initial dose for pediatric caudal epidural morphine administration.
- Careful monitoring for side effects, including respiratory depression, is warranted.
Abstract:
The authors compared the duration of analgesia and the frequency of side effects of three doses of caudal epidural morphine in children aged 1.2-7.9 yr. Caudal catheters were inserted in 32 children, randomly assigned to receive 0.033 mg.kg-1, 0.067 mg.kg-1, or 0.10 mg.kg-1 of preservative-free morphine for analgesia after major surgical procedures below the diaphragm. The first dose of caudal morphine was mixed with 0.25 ml.kg-1 of 1% lidocaine to confirm correct caudal catheter placement. By assessment of periodic pain scores and the time intervals between administration of caudal morphine and the recurrence of pain, the authors found that the mean (+/- SD) duration of analgesia was significantly longer after 0.10 mg.kg-1 (13.3 +/- 4.7 h) than after either 0.033 mg.kg-1 or 0.067 mg.kg-1 (10.0 +/- 3.3 and 10.4 +/- 4.2 h, respectively) (P less than 0.02). The frequency of vomiting, pruritus, and urinary retention was similar in each group. Vomiting was less common in patients who had nasogastric drainage than in patients who were fed soon after surgery (P less than 0.05). Delayed respiratory depression occurred in one child after 0.10 mg.kg-1 of caudal morphine. Caudal morphine, 0.033-0.10 mg.kg-1, provided prolonged analgesia in children. The authors recommend 0.033 mg.kg-1 of caudal morphine as an initial dose for children.