Postoperative use of epidurally administered morphine in children and adolescents

Epidurally administered narcotics are increasingly used to provide relief of pain in adults after major surgical procedures. This report describes the use of epidurally administered morphine for postoperative analgesia in nine pediatric patients after 15 major surgical procedures. The mean dose of morphine was 0.12 +/- 0.03 mg/kg of body weight, and the mean duration of analgesia per dose was 10.8 +/- 4.0 hours. Catheters remained in place for a mean duration of 50.3 +/- 16.0 hours. Increasing the dose of morphine to more than 0.1 mg/kg did not prolong the duration of analgesia but it did increase the frequency of side effects. No complications from placement of the catheter and no serious side effects were encountered. The postoperative requirements for narcotics were significantly less in the patients who received morphine epidurally than in those who received narcotics parenterally. Epidurally administered morphine can provide reliable postoperative analgesia in pediatric patients. The potential benefits include improved quality of pain relief at low total requirements, improved pulmonary function, and early ambulation.