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Caudal Morphine in Pediatric Patients: A Comparison of Two Different Doses in Children Undergoing Infraumbilical
Sushree Das1, Ranjita Acharya1, Madhusmita Patro1
1Department of Anesthesiology and Pain Medicine, IMS and Sum Hospital, Bhubaneswar, Odisha, India.
Insights
Lower doses of caudal epidural morphine (20 μg/kg) provide effective pain relief for pediatric infraumbilical surgeries with fewer side effects than higher doses (30 μg/kg). This finding optimizes pediatric pain management strategies.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Regional Anesthesia
Background:
- Pain is a significant symptom in pediatric patients, necessitating effective management strategies.
- Caudal epidural analgesia is a common technique for intra- and postoperative pain control in children undergoing infraumbilical surgeries.
- Morphine as an adjunct to ropivacaine in caudal blocks can enhance analgesia quality and duration.
Purpose of the Study:
- To compare the efficacy and safety of two different doses of caudal epidural morphine (20 μg/kg vs. 30 μg/kg) as an adjunct to ropivacaine in pediatric infraumbilical surgeries.
- To evaluate the impact of morphine dosage on the duration of analgesia and the incidence of side effects.
Main Methods:
- A prospective, randomized, double-blinded study involving 60 pediatric patients.
- Patients were divided into two groups: Group A received 20 μg/kg morphine with 0.2% ropivacaine, and Group B received 30 μg/kg morphine with 0.2% ropivacaine.
- Vital signs, pain scores, and sedation scores were monitored for 24 hours post-procedure.
Main Results:
- The mean duration of analgesia was comparable between groups (20.5 hours in Group A vs. 22.2 hours in Group B).
- Group A required less rescue analgesia (83.3% vs. 66.7%) and had fewer children with no analgesic requirement (16.7% vs. 33.3%).
- Side effects, primarily nausea and vomiting, were significantly more frequent in Group B (26.7%) compared to Group A (6.6%).
Conclusions:
- A lower dose of morphine (20 μg/kg) combined with ropivacaine for caudal epidural block offers comparable analgesia duration to a higher dose (30 μg/kg).
- The 20 μg/kg morphine dosage demonstrates superior efficacy due to a similar duration of pain relief and a reduced incidence of adverse effects.
- This suggests that 20 μg/kg morphine is a more optimal dose for caudal epidural analgesia in pediatric infraumbilical surgeries.
Background:
One of the most feared symptoms of any disease is PAIN. It is a complex phenomenal experience, especially in children. Various methods and medications have been administered through different routes. Regional anesthesia produces marvelous postoperative analgesia and cessation of stress response in infants and children. Caudal epidural analgesia is the most acceptable and popular method of providing intra- and postoperative analgesia for abdominal, perineal, and lower limb surgeries in children. The use of preservative-free morphine as an adjunct to ropivacaine increases the quality and duration of analgesia despite the various side effects. Various articles use various doses of morphine as an adjuvant in caudal epidural analgesia. Hence, we conducted the study to compare the two dosages of morphine that is 20 μg.kg-1 and 30 μg.kg-1 of caudal epidural morphine for infraumblical surgeries with regard to its efficacy and safety and side effect profiles.
Materials And Methods:
The study is a prospective, randomized, double-blinded study. Sixty patients were divided into two groups. Group A: 20 μg.kg-1 of morphine was added to 0.2% ropivacaine 1 mL.kg-1 and the solution was made. Group B: 30 μg.kg-1 of morphine was added to 1 mL.kg-1 of 0.2% ropivacaine. Heart rate, systolic blood pressure, diastolic blood pressure, SPO2, pain score, and sedation score were recorded immediately, after 15 min, 30 min, 45 min, 1 h, 2 h, 4 h, 8 h, 12 h, 16 h, 18 h, and 24 h were recorded.
Results:
The mean duration of analgesia is similar in both groups (P = 0.011). The mean duration was 20.517 ± 1.9143 h in Group A and 22.233 ± 1.6853 h in Group B. Children with the requirement of one dose of rescue analgesia in Group A was 83.3% which was higher than Group B being 66.7%. Children with no analgesic requirement were 16.7% in Group A and 33.3% in Group B. The incidence of side effects was more in Group B (8 [26.7%] children with nausea and vomiting; 1 [3.3%] children with urinary retention) than in Group A (2 [6.6%] children with nausea and vomiting.
Conclusion:
From the above observations, it can be concluded that morphine of less dosage (20 μg.kg-1) when added to 0.2% ropivacaine for the caudal epidural block has better efficacy than morphine of higher dosage (30 μg.kg-1) as the duration of analgesia is similar with decreased incidence of side effects.
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