Single-dose caudal epidural morphine in children: Safe, effective, and easy

Caudal bupivacaine supplemented with morphine or clonidine, or supplemented with morphine plus clonidine in children undergoing infra-umbilical urological and genital procedures: a prospective, randomized and double-blind study

“…It was demonstrated that a significantly larger percentage of pediatric patients undergoing ureteral reimplantation who received caudal clonidine (2 lg/kg) in 0.2% ropivacaine required IV morphine in the PACU compared with the percentage of patients who had received morphine (50 lg/kg), combined with 0.2% ropivacaine [26]. Another study showed that forty-seven percent of children who had received a single dose of epidural morphine (60 lg/kg) for major orthopedic, thoracic, genitourinary, or abdominal surgical procedures required no parenteral analgesic for 12 h after receiving this agent at this dose [27].…”

Comparison of caudal morphine and tramadol for postoperative pain control in children undergoing inguinal herniorrhaphy

“…A lower dosage in our patients may have resulted in fewer side-effects, including respiratory depression. Another study (13) showed that, with 0.03±0.04 mgákg ±1 morphine administered caudally, the minimum duration of pain relief was 6 h and the maximum duration was 24 h. Serlin et al reported that 47% of patients required no parenteral analgesic for 12 h after receiving a single dose of epidural morphine (0.06 mgákg ±1 ) (14). Krane also reported that 0.033 mgákg ±1 of caudal morphine provided effective analgesia for more than 8 h in the most children (4).…”

Epidural and intravenous bolus morphine for postoperative analgesia in infants

“…Several previous reports including both infants and children have established the effectiveness of epidural morphine 0.050-0.070 mg-kg -I in the control of postoperative pain, 6,8,18,19 although these reports made no attempt to determine the optimal dose or to compare epidural with other routes of administration. The higher doses utilized in these studies provided longer duration of analgesia (mean duration >10 hr) than we found in our epidural groups (mean 7-8 hr) and were associated with serious side effects: excessive sedation (0-4%); respiratory depression (0-8%), especially in infants who received intravenous opioids intraoperatively; 6,8 nausea and vomiting (0-31%); urinary retention (7-50%); and pruritus (3-88%).…”