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Postoperative analgesia in children using continuous s.c. morphine
1Department of Anaesthesia, Royal Hospital for Sick Children, Yorkhill, Glasgow.
Insights
This study demonstrates that a continuous subcutaneous morphine infusion provides effective postoperative pain relief for children after major surgery. This method ensures high patient comfort with minimal side effects, allowing nursing staff to adjust infusion rates as needed.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Surgical Care
Background:
- Effective postoperative pain management is crucial for pediatric surgical patients.
- Traditional analgesia methods may have limitations in providing sustained pain relief.
- Optimizing pain control can improve patient recovery and reduce complications.
Purpose of the Study:
- To evaluate the efficacy and safety of a subcutaneous morphine infusion for postoperative analgesia in children undergoing major surgery.
- To assess pain, sedation, and nausea/vomiting scores in pediatric patients receiving this analgesia technique.
- To determine the feasibility of nursing staff adjusting morphine infusion rates based on patient needs.
Main Methods:
- A balanced anesthesia technique including bupivacaine (epidural or nerve block) was used.
- Postoperative analgesia involved a subcutaneous infusion of morphine (1 mg/kg) at 0.3-0.5 ml/h.
- Monitoring included SpO2, pain, sedation, and nausea/vomiting scores, with infusions lasting an average of 38.8 hours.
Main Results:
- 97% of SpO2 recordings were >94%, with only one instance below 90%.
- 94% of pain scores indicated no or slight pain; only 1% reported severe pain.
- 99.7% of sedation scores indicated patients were awake or rousable; 2.8% reported nausea/vomiting, with only two cases troublesome.
Conclusions:
- Continuous subcutaneous morphine infusion is a safe and effective method for pediatric postoperative pain management.
- The technique allows for stable oxygen saturation, minimal sedation, and low incidence of nausea/vomiting.
- Nursing staff empowerment to adjust infusion rates enhances patient comfort and pain control efficacy.
Abstract:
Sixty children (7 months-20 yr; mean 6.5 yr, median 7-8 yr, mode 1-2 yr) undergoing major surgery received a balanced technique of general anaesthesia combined with bupivacaine as a single injection extradural or peripheral nerve block. Postoperative analgesia consisted of a subcutaneous infusion of morphine 1 mg kg-1 body weight in 20 ml of normal saline [corrected] at a rate of 0.3-0.5 ml h-1, controlled by the nursing staff in the surgical ward. Monitoring included SpO2, pain, sedation and nausea/vomiting scores. Infusions were used for a mean of 38.8 h (range 17-80 h). Ninety-seven percent of recordings of SpO2 were greater than 94% and only one recording in 2361 was less than 90%. Ninety-four percent of pain scores indicated either no pain or slight pain; 1% indicated severe pain. On the order of the medical staff, seven children had the rate of infusion of morphine increased to 0.6 ml h-1 [corrected] because of high pain scores. Sedation scores compatible with children being either awake or asleep but rousable by speech alone were recorded on 99.7% of occasions. No child at any time was unrousable. Of 1248 nausea/vomiting scores, only 2.8% indicated the presence of these side effects; in only two children were they thought to be troublesome. As a result of this audit, nursing staff have been permitted to increase the rate of infusion of morphine to 0.6 ml h-1 [corrected] if required.