Comparison of oral and intravenous morphine following acute injury in children

Abstract

The objective of this research was to examine the speed of onset and effectiveness of pain relief between oral and intravenous morphine in acutely injured children. An observational study of children aged 3 to 13 years with closed forearm fractures was performed in three accident and emergency departments. The study gathered information on age, gender, body weight, time of arrival, dose, route and time of morphine administration. Pain assessment using a Faces Scale was documented on arrival and repeated at 10, 30 and 60 minutes after morphine was given. Forty-seven children were studied. Of these, 25 were given intravenous morphine, 22 were given oral morphine. There was no statistically significant difference in age, body weight or time until morphine was administered. The change in median pain scores was analysed using the Mann-Whitney U test. This showed that there was a statistically significant reduction in pain score in the intravenous group compared with the oral group between arrival and 10 minutes after giving morphine and between arrival and 60 minutes after giving morphine. Intravenous morphine appears to give more rapid onset and more prolonged pain relief than oral morphine for children with acute injuries. We recommend that in accident and emergency departments where staff are experienced in paediatric cannulation, morphine should be given via the intravenous route in acutely injured children. However we do not advocate inexperienced staff attempting multiple venepunctures in a child resulting in increased anxiety.

Comparative review of the clinical use of intranasal fentanyl versus morphine in a paediatric emergency department

“…It has been demonstrated in the past that there is a significant reduction in the pain score in children receiving i.v. morphine compared with oral morphine in acute injuries 1 . As intranasal fentanyl (INF) is equivalent in effectiveness to i.v.…”

“…morphine compared with oral morphine in acute injuries. 1 As intranasal fentanyl (INF) is equivalent in effectiveness to i.v. morphine, 2 without the invasive procedure, it has attributes to be a superior agent in managing initial acute pain in this setting.…”

Oral administration of morphine versus ibuprofen to manage postfracture pain in children: a randomized trial

“…20 In an observational study comparing morphine administered intravenously with morphine administered orally, intravenous administration (0.2-0.4 mg/kg) resulted in greater pain reduction as assessed by a 5-item faces pain scale. 27 We found children in the morphine group had significantly more adverse effects. Previous studies have described similar frequencies of nausea, vomiting and drowsiness, 28 consistent with the expected adverse effects of morphine.…”

Oral morphine versus ibuprofen administered at home for postoperative orthopedic pain in children: a randomized controlled trial

“…Thirty minutes is the time to a clinically significant reduction in pain, 23,36 to peak plasma concentration for oral morphine 37 and to onset of analgesia for ibuprofen. 38 Consistent with the described use of the Faces Pain ScaleRevised, 39 we instructed all children to circle the face on the horizontal axis that corresponded to their pain level.…”