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Published on: July 29, 2014
Effect of intra-op morphine on children with OSA undergoing tonsillectomy
Daniel C O'Brien1, Yuti Desai2, Jane Schubart3
1Department of Otolaryngology - Head and Neck Surgery, West Virginia University School of Medicine, Morgantown, WV, USA.
Insights
Intra-operative morphine in pediatric obstructive sleep apnea (OSA) patients undergoing tonsillectomy did not increase recovery room time or emergency department visits but did result in a longer length of stay.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Anesthesiology
- Sleep Medicine
Background:
- Obstructive sleep apnea (OSA) is a common condition in children undergoing tonsillectomy.
- Pain management after tonsillectomy is crucial for pediatric patients.
- The use of intra-operative morphine for pain control in these patients requires further investigation.
Purpose of the Study:
- To compare outcomes in pediatric tonsillectomy patients with OSA who received intra-operative morphine versus those who did not.
- To evaluate the impact of intra-operative morphine on recovery room time, length of stay, and emergency department visits.
Main Methods:
- Retrospective case series with chart review.
- Inclusion of pediatric patients (1-17 years) who underwent tonsillectomy between 2013 and 2016.
- Comparison of outcomes between patients who received intra-operative morphine and those who did not.
Main Results:
- No significant differences were observed in recovery room time, emergency department visits, or airway complications between the groups.
- Patients receiving intra-operative morphine had a significantly longer length of stay (25.9 vs. 21.4 hours).
- The group receiving intra-operative morphine had fewer episodes of obstructive apnea and hypopnea (AHI).
Conclusions:
- Intra-operative morphine use in pediatric tonsillectomy patients with OSA is associated with an increased length of hospital stay.
- The findings suggest a need for closer examination of intra-operative morphine's role in this specific patient population.
- Alternative pain management strategies may be considered to optimize outcomes.
Objectives:
1. To compare outcomes after tonsillectomy for pediatric patients with obstructive sleep apnea (OSA) given morphine intra-operatively and post operatively compared to those who were not - specifically Recovery Room (RR) time, length of stay (LOS), Emergency Department (ER) visits.
Study Design:
Retrospective case series with chart review.
Setting:
Tertiary care children's hospital.
Subjects And Methods:
All children between 1 and 17 years old who had undergone tonsillectomy in a single institution from 2013 to 2016. Comparison between children who had received morphine intra-operatively was made for outcomes.
Results:
556 patients were included, 73 patients had morphine intraoperatively and 483 did not; these latter children were older (8.8 vs 6.5 years, P < 0.001), and had fewer episodes of obstructive apnea and hypopnea (AHI 4.47 vs 10.15, p = 0.003) than children who did not receive intra-op morphine. There were no differences in co-morbidities including asthma, whether they had a sleep study, time in the operating room, emergence time, RR time, airway complications, IMC/PICU admission for respiratory distress, ER visits, readmissions, bleeding or post-discharge nurse phone calls. There was a longer LOS (25.9 vs 21.4 h, P = 0.011) for the group receiving intra-op morphine.
Conclusion:
Children with OSA who receive intra-op morphine have a longer LOS suggesting that its use should be examined more closely in this population.
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