Abstract | BACKGROUND:
Morphine is commonly used for postoperative analgesia in children. Here we studied the pharmacodynamics of morphine in children after cardiac surgery receiving protocolized morphine. METHODS: Data on morphine rescue requirements guided by validated pain scores in children (n = 35, 3-36 months) after cardiac surgery receiving morphine as loading dose (100 μg kg-1) with continuous infusion (40 μg kg-1 h-1) from a previous study on morphine pharmacokinetics were analysed using repeated time-to-event (RTTE) modelling. RESULTS: During the postoperative period (38 h (IQR 23-46)), 130 morphine rescue events (4 (IQR 1-5) per patient) mainly occurred in the first 24 h (107/130) at a median morphine concentration of 29.5 ng ml-1 (range 7-180 ng ml-1). In the RTTE model, the hazard of rescue morphine decreased over time (half-life 18 h; P < 0.001), while the hazard for rescue morphine (21.9% at 29.5 ng ml-1) increased at higher morphine concentrations (P < 0.001). CONCLUSIONS: IMPACT: In children receiving continuous morphine infusion, administration of rescue morphine is an indicator for insufficient effect or an event. Morphine rescue events were identified at a wide range of morphine concentrations upon a standardized pain protocol consisting of continuous morphine infusion and morphine as rescue boluses. The expected number of rescue morphine events was found to increase at higher morphine concentrations. Instead of exploring more aggressive morphine dosing, future research should focus on a multimodal approach to treat breakthrough pain in children.
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Authors | Sjoerd de Hoogd, Sebastiaan C Goulooze, Abraham J Valkenburg, Elke H J Krekels, Monique van Dijk, Dick Tibboel, Catherijne A J Knibbe |
Journal | Pediatric research
(Pediatr Res)
Vol. 90
Issue 6
Pg. 1201-1206
(12 2021)
ISSN: 1530-0447 [Electronic] United States |
PMID | 33603216
(Publication Type: Journal Article)
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Copyright | © 2021. The Author(s), under exclusive licence to the International Pediatric Research Foundation, Inc. |
Chemical References |
- Analgesics, Opioid
- Morphine
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Topics |
- Analgesics, Opioid
(administration & dosage)
- Breakthrough Pain
(drug therapy)
- Child
- Dose-Response Relationship, Drug
- Female
- Humans
- Male
- Morphine
(administration & dosage)
- Pain, Postoperative
(drug therapy)
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