Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Abstract

Background and Aims:Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects.Material and Methods:This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted.Results:The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting.Conclusion:CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

Comparison of caudal ropivacaine‐morphine and paravertebral catheter for major upper abdominal surgery in infants

“…Our results were partially consistent with these reports, and therefore advocate that a single shot of morphine (our median dose = 0.03 mg·kg −1 ) via caudal block can provide analgesia that lasts less than 24 h and that the abovementioned dose does not significantly contribute to negative effects in infants. Our findings were also consistent with that of a recent study, which demonstrated that a low dose of morphine (0.03 mg·kg −1 ) can provide analgesia lasting up to 12 h with minimal side effects, while higher doses of morphine (0.07 mg·kg −1 ) are associated with sedation and respiratory depression .…”

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

“…Saadawy et al reported that the duration of analgesia was 6.2±2.8 hours in patients who underwent caudal block and were administered 1 mg/kg of 0.25% bupivacaine, while it was 18.5±2.8 hours in patients who underwent caudal block and were administered 1 mg/kg bupivacaine added to 1 µg dexmetodomine 11. In another study, Baduni et al compared 1 mg/kg of 0.25% bupivacaine to clonidine added to the same dose of local anesthetic; he reported that the duration of analgesia was 295.00±41.78 min in the bupivacaine group and 724.80±60.29 min in the bupivacaine+clonidine group 12. Sanwatsarkar et al also performed caudal block with 0.75 mL/kg of 0.25% bupivacaine and added 50 µg/kg morphine for patients who underwent lower abdominal and urogenital surgeries; the duration of analgesia was 13.36±2.47 hours 13.…”

Caudal catheter placement for repeated epidural morphine doses after neonatal upper abdominal surgery

“…17 Several studies in older children (one to 12 years of age) also showed excellent analgesia, with rare respiratory depression (only requiring naloxone when morphine 70 μg/kg was used). 14,18 –21…”