Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine.

Abstract

STUDY OBJECTIVE:

To determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles.

DESIGN:

Prospective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort.

SETTING:

Metropolitan hospital in the Philippines.

PATIENTS:

24 ASA physical status I and II children undergoing frontal encephalocele repair.

INTERVENTIONS:

Following induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2).

MEASUREMENTS AND MAIN RESULTS:

Group 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1.6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours.

CONCLUSION:

Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.

• Authors: J D Tobias, C Mateo, M J Ferrer, D F Jimenez, C M Barone, L Reyes de Castro
• Journal: Journal of clinical anesthesia (J Clin Anesth) Vol. 9 Issue 4 Pg. 280-4 (Jun 1997) ISSN: 0952-8180 [Print] United States
• PMID: 9195349 (Publication Type: Clinical Trial, Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Analgesics, Opioid
• Morphine
• Nalbuphine

Topics

• Analgesics, Opioid (adverse effects, therapeutic use)
• Child
• Child, Preschool
• Encephalocele (surgery)
• Female
• Frontal Lobe (surgery)
• Humans
• Injections, Intravenous
• Injections, Spinal
• Male
• Morphine (adverse effects, therapeutic use)
• Nalbuphine (administration & dosage, therapeutic use)
• Pain Measurement
• Pain, Postoperative (drug therapy)
• Prospective Studies
• Retrospective Studies