Caudal Morphine for Postoperative Analgesia in Infants and Children

Complications of continuous epidural infusions for postoperative analgesia in children

“…It was suggested on the basis of this experience that the risk of respiratory depression was greater in patients < 12 mo old and when additional parenteral opioids had been given. 21 In our patients, epidural morphine was not used. Parenteral opioids were not given during the use of epidural opioids.…”

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%).…”

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.…”