Safety and efficacy of continuous morphine infusions following pediatric cranial surgery in a surgical ward setting

Warren, Daniel T.; Bowen-Roberts, Tim; Ou, Christine; Purdy, Robert H.; Steinbok, Paul

doi:10.1007/s00381-010-1123-0

Cited by 19 publications

(9 citation statements)

References 19 publications

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“…Our study revealed that in both younger and older pediatric patients, morphine administration was the most effective regimen of PCIA or NCIA after neurosurgery. These results are consistent with those of Warren 22 who suggested continuous morphine infusions (CMI) had an analgesic effect comparable to that of acetaminophen and codeine; yet codeine phosphate alone is typically preferred as the standard treatment for pain after cranial surgery. The fentanyl and tramadol group had similar analgesic effects; echoing results by Alencar 23 in neonates.…”

Section: Discussionsupporting

confidence: 89%

Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

Xing

Xue

et al. 2019

Preprint

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Background: Pain is often observed in pediatric patients after craniotomy procedures, which could lead to some serious postoperative complications. However, the optimal formula for postoperative analgesia for pediatric neurosurgery has not been well established. This study aimed to explore the optimal options and formulas for postoperative analgesia in pediatric neurosurgery. Methods: Three hundred and twenty patients aged 1 to 12-years old who underwent craniotomy were randomly assigned to receive 4 different regimens of patient-controlled analgesia (PCIA or NCIA). Postoperative pain scores at different time point after surgery and analgesia-related complication were recorded respectively. Comparative analysis was performed between the four groups. Results: In all groups, significantly lower pain scores were observed at one to 8 hours in the morphine group (P<0.05). There was no significant difference in pain scores between the fentanyl and tramadol groups (P>0.05), both of which had lower pain scores than the placebo group (P<0.05). However, a higher incidence of nausea and vomiting occurred in the tramadol group during the 48 hours of NCIA usage after operation (P=0.020). Much more rescue medicines including ibuprofen and morphine were used in control group (CI=0.000-0.019). No consciousness change and respiratory depression was observed in all groups. There were 56 children experienced moderate-severe pain(17.5%), younger children (OR=1.161, 1.027-1.312, P=0.017), occipital craniotomy (OR=0.374, 0.155-0.905, P=0.029), morphine treatment, were relevant factors of moderate-severe pain in pediatric patients. Conclusions: Compared with other analgesic projects, PCIA or NCIA analgesia with morphine appears to be the safest and most effective postoperative analgesia program for pediatric patients who underwent neurosurgical operations. Trial registration: Chinese Clinical Trial Registry. No: ChiCTR-IOC-15007676. Prospective registration. http://www.chictr.org.cn. Keywords: Pain, Postoperative, Child, Craniotomy

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Section: Discussionsupporting

confidence: 89%

Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

Xing

Xue

et al. 2019

Preprint

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“…Opioids are generally considered to be the most effective analgesics, but they also carry the greatest risk of adverse effects [33]. Recommendations to improve safety while using opioid analgesics include dosing them by ideal body weight instead of actual body weight, and using opioids such as oxycodone and hydrocodone that do not rely on metabolism to achieve their analgesic effect [17,34,35].…”

Section: What Opioid Analgesics Are Available For Pain Control For Pementioning

confidence: 99%

Oxycodone Overdose in the Pediatric Population: Case Files of the University of Massachusetts Medical Toxicology Fellowship

Boyle

Rosenbaum

2014

J. Med. Toxicol.

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“…Pain control involves a continuous morphine infusion protocol that has been described in previous publications. 8,11…”

Section: Methodsmentioning

confidence: 99%

Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis

Bonfield

Basem

Cochrane

et al. 2018

Journal of Neurosurgery: Pediatrics

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OBJECTIVEAt British Columbia Children’s Hospital (BCCH), pediatric patients with nonsyndromic craniosynostosis are admitted directly to a standard surgical ward after craniosynostosis surgery. This study’s purpose was to investigate the safety of direct ward admission and to examine the rate at which patients were transferred to the intensive care unit (ICU), the cause for the transfer, and any patient characteristics that indicate higher risk for ICU care.METHODSThe authors retrospectively reviewed medical records of pediatric patients who underwent single-suture or nonsyndromic craniosynostosis repair from 2011 to 2016 at BCCH. Destination of admission from the operating room (i.e., ward or ICU) and transfer to the ICU from the ward were evaluated. Patient characteristics and operative factors were recorded and analyzed.RESULTSOne hundred fourteen patients underwent surgery for single-suture or nonsyndromic craniosynostosis. Eighty surgeries were open procedures (cranial vault reconstruction, frontoorbital advancement, extended-strip craniectomy) and 34 were minimally invasive endoscope-assisted craniectomy (EAC). Sutures affected were sagittal in 66 cases (32 open, 34 EAC), coronal in 20 (15 unilateral, 5 bilateral), metopic in 23, and multisuture in 5. Only 5 patients who underwent open procedures (6%) were initially admitted to the ICU from the operating room; the reasons for direct admission were as follows: the suggestion of preoperative elevated intracranial pressure, pain control, older-age patients with large reconstruction sites, or a significant medical comorbidity. Overall, of the 107 patients admitted directly to the ward (75 who underwent an open surgery, 32 who underwent an EAC), none required ICU transfer.CONCLUSIONSOverall, the findings of this study suggest that patients with nonsyndromic craniosynostosis can be managed safely on the ward and do not require postoperative ICU admission. This could potentially increase cost savings and ICU resource utilization.

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Safety and efficacy of continuous morphine infusions following pediatric cranial surgery in a surgical ward setting

Cited by 19 publications

References 19 publications

Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

Postoperative Analgesia for Pediatric Craniotomy Patients: A Randomized Controlled Trial

Oxycodone Overdose in the Pediatric Population: Case Files of the University of Massachusetts Medical Toxicology Fellowship

Examining the need for routine intensive care admission after surgical repair of nonsyndromic craniosynostosis: a preliminary analysis

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