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Double-blind, multiple-dose comparison of buprenorphine and morphine in postoperative pain of children
E L Maunuksela1, R Korpela, K T Olkkola
1Children's Hospital, University of Helsinki, Finland.
Insights
This study found that buprenorphine is as effective as morphine for managing postoperative pain in children after lateral thoracotomy. Both drugs provided similar pain relief, with buprenorphine showing a slightly longer duration of action.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Postoperative pain management in children is crucial for recovery.
- Opioid analgesics like morphine and buprenorphine are commonly used.
- Evaluating the efficacy and safety of different analgesics is essential.
Purpose of the Study:
- To compare the efficacy of intravenous morphine and buprenorphine for pain relief in children undergoing lateral thoracotomy.
- To assess cardioventilatory indices, pain intensity, and sedation levels.
- To determine optimal dosing strategies for these analgesics.
Main Methods:
- A randomized, double-blind study involving 57 children (6 months to 6 years).
- Administration of repeated intravenous doses of morphine (100 or 50 µg/kg) or buprenorphine (3.0 or 1.5 µg/kg).
- Monitoring of pain intensity, sedation, and cardioventilatory parameters over 24 hours.
Main Results:
- Both morphine and buprenorphine demonstrated equal efficacy in relieving pain.
- Buprenorphine exhibited a slightly, though not significantly, longer duration of action compared to morphine.
- Lower initial bolus doses of both drugs resulted in reduced total consumption.
- Two patients experienced ventilatory depression with buprenorphine.
Conclusions:
- Buprenorphine is an effective alternative to morphine for postoperative analgesia in pediatric patients following lateral thoracotomy.
- Dosing strategies should consider potential ventilatory effects, especially with buprenorphine.
- Further research may optimize the use of these agents to balance efficacy and safety.
Abstract:
In a randomized double-blind study of 57 children (aged 6 months-6 yr), pain following lateral thoracotomy was relieved with repeated i.v. doses of morphine 100 or 50 micrograms kg-1, or buprenorphine 3.0 or 1.5 micrograms kg-1. The same drug and dosage were continued and cardioventilatory indices, pain intensity and sedation measured for an observation period of 24 h. The sums of the pain intensity differences were equal in all groups. The mean doses for the complete initial analgesia were 230 and 180 micrograms kg-1 with the larger and the smaller bolus doses of morphine and 5.8 and 3.7 micrograms kg-1 with buprenorphine, respectively. The mean duration of action of buprenorphine was slightly but not significantly longer than that of morphine. The total consumption of both morphine and buprenorphine was less when the smaller bolus doses were used. Two patients developed a degree of ventilatory depression following repeated doses of buprenorphine. Buprenorphine was equal to morphine as a postoperative analgesic.