Comparison of epidural morphine, hydromorphone and fentanyl for postoperative pain control in children undergoing orthopaedic surgery

Abstract

The safety and side-effects profile of epidural administration of a hydrophilic (morphine), highly lipophilic (fentanyl) and a drug with intermediate hydrophilic and lipophilic activity (hydromorphone) were compared in 90 children undergoing orthopaedic procedures. Ninety patients were randomly assigned (30 in each group) to receive epidural morphine, hydromorphone, or fentanyl for postoperative analgesia. Respiratory effects, nausea, somnolence, urinary retention, pruritus and visual pain scales were evaluated and compared during a 30-h period following surgery. In the morphine group, 25% showed respiratory depression with oxygen saturation below 90% but there was no incidence of respiratory depression in the fentanyl or hydromorphone groups. Somnolence was prominent in some of the patients in all the groups, but was more prolonged in the morphine group. Statistically, there was no significant difference in nausea between the groups, but pruritus was more severe and frequent in the morphine group. The incidence of urinary retention in the morphine group was higher compared with the fentanyl and hydromorphone groups. In conclusion, epidural hydromorphone, demonstrating less side-effects, is preferable to morphine and fentanyl for epidural analgesia in children.

What Epidural Opioid Results in the Best Analgesia Outcomes and Fewest Side Effects After Surgery?

“…44 In addition, the majority of trials made a binary comparison between two different opioids, except the pediatric study by Goodarzi that compared morphine, fentanyl, and hydromorphone (Table 1). 43 …”

The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients

“…Overall, the reported incidence of respiratory depression associated with epidural opioids is 0% to 1.9% in adults (Table 3) (1,2,4-19) and 0-25% in children (Table 4) (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30). The rates most commonly reported in children are 0.5%-1% (24).…”

“…However, when reduced respiratory rate and oxygen saturation are included as criteria, rates of 0.07 %-1.2% are reported in adults (Table 3) (4-6,8,11-14,16). Similarly, pediatric studies of epidural analgesia have used two broad definitions of respiratory depression: 1) clinically significant episodes such as re-intubation, use of naloxone or apnea (20,22,29,30); and 2) definitions that include minor events such as respiratory rate <10 per minute or oxygen saturation < 90% (23,25). One potential criticism of our study is that it did not use age specific respiratory rates, which may be relevant in small children and babies.…”

Comparison of thoracic epidural and paravertebral analgesia for postoperative pain control after thoracotomy

“…[22] Görülme sıklığı kullanılan opioidin tipine bağlıdır, morfin, fentanil ve hidromorfondan ile daha sık görülür. [23] Bizim olgularımızda da her iki grupta en yaygın gözlenen yan etki kaşıntı idi. ED grubunda %34 ve PV grubunda %23 sıklıkta gözlendi.…”