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Efficacy of a low-dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair.

AbstractBACKGROUND:
Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double-blinded, randomized, and placebo-controlled study to compare the efficacy of a low-dose (2 microg x kg(-1)) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia.
METHODS:
Fifty-four children were randomly assigned to one of two spinal anesthesia groups. Group M (n = 27) received hyperbaric bupivacaine plus 2 microg x kg(-1) of preservative-free morphine and group P (n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain-requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children's Hospital of Eastern Ontario Pain Scale.
RESULTS:
Forty-nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M (P = 0.005). Mean duration of analgesia was 480 +/- 209 and 720 +/- 190 min in group P and group M respectively (P = 0.009). The groups were similar in postoperative side effects.
CONCLUSION:
Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 microg x kg(-1) intrathecal morphine provides better postoperative pain control when compared to placebo in these children.
AuthorsSeza Apiliogullari, Ates Duman, Funda Gok, Isak Akillioglu, Ilhan Ciftci
JournalPaediatric anaesthesia (Paediatr Anaesth) Vol. 19 Issue 11 Pg. 1078-83 (Nov 2009) ISSN: 1460-9592 [Electronic] France
PMID19708911 (Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial)
Chemical References
  • Analgesics
  • Analgesics, Opioid
  • Anesthetics, Local
  • Morphine
  • Bupivacaine
Topics
  • Analgesics (administration & dosage)
  • Analgesics, Opioid (administration & dosage)
  • Anesthesia, Spinal (methods)
  • Anesthetics, Local (administration & dosage)
  • Bupivacaine (administration & dosage)
  • Child
  • Child, Preschool
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Humans
  • Hypospadias (surgery)
  • Male
  • Morphine (administration & dosage)
  • Pain, Postoperative (prevention & control)
  • Treatment Outcome

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