Epidural Morphine Analgesia in Children

Shapiro, Lev A.; Jedeikin, Robert; Shalev, Daniel; Hoffman, Seymour

doi:10.1097/00000542-198408000-00019

Cited by 49 publications

(13 citation statements)

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“…The untoward side effects that occur with epidural mor phine appear to be primarily mediated by the mu receptors [26,27], By adding a narcotic agonist/antagonist such as butorphanol, one may selectively block the mu receptors without significantly decreasing analgesia. Support for this hypothesis has been provided in both obstetrical and pediatric patients [15][16][17], The duration of pain control following a single bolus was similar in this study to pre viously published reports in which up to 18 h of pain relief could be anticipated [21,28].…”

Section: Discussionsupporting

confidence: 84%

“…This consists not only of incisional pain, but dysesthetic pain in the lower extremities as well [1,2,20]. In patients undergoing thoracoabdominal or spine procedures, epidu ral opioids have been shown to provide highly effective analgesia with an extended analgesic effect and minimal sedation [21][22][23], However, opioid side effects, including nausea, vomiting, pruritus, urinary retention, and respira tory depression, still occur in 20-50% of patients [24,25]. The untoward side effects that occur with epidural mor phine appear to be primarily mediated by the mu receptors [26,27], By adding a narcotic agonist/antagonist such as butorphanol, one may selectively block the mu receptors without significantly decreasing analgesia.…”

Section: Discussionmentioning

confidence: 99%

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Epidural Pain Management in the Postrhizotomy Patient

Boop

Brown

et al. 1994

Pediatr Neurosurg

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The authors report a randomized double-blind prospective study comparing epidural morphine 80 µg/kg to epidural morphine 80 µg/kg plus butorphanol 40 µg/kg in children undergoing rhizotomy. Up to 50% of children receiving epidural morphine alone will experience side effects of nausea, vomiting, pruritus, urinary retention or respiratory depression. The addition of the narcotic agonist-antagonist butorphanol virtually eliminated these side effects without compromising analgesia or causing undue sedation. Parent satisfaction was greater than 90%.

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Section: Discussionsupporting

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Epidural Pain Management in the Postrhizotomy Patient

Boop

Brown

et al. 1994

Pediatr Neurosurg

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“…In our paediatric patients we have chosen ITM over previously described epidural/caudal morphine administration Uensen 1981; Glenski et al 1984;Shapiro et al 1984;Attia et al 1986; Dalens, Tanguy S.W. KRECHEL ET A L .…”

Section: Discussionmentioning

confidence: 99%

Intrathecal morphine (ITM) for postoperative pain control in children: a comparison with nalbuphine patient controlled analgesia (PCA)

Krechel

Helikson

Kittle

et al. 1995

Pediatric Anesthesia

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This is a retrospective study covering the ten-year period 1984-1993. Single shot spinal morphine (ITM) is compared with PCA nalbuphine for postoperative pain relief in children having abdominal or thoracic procedures. The records of 52 patients meeting selection criteria were examined. Nursing and physician notations were reviewed for hourly pain assessments, evidence of associated complications, respiratory depression, nausea and or vomiting, pruritus, and urinary retention. ITM provided significantly better pain relief (2.2 h in pain) during the first 24 h postoperatively than PCA nalbuphine (9.2 h in pain). With the exception of urinary retention which was significantly more frequent following ITM (58.6%) compared to PCA nalbuphine (8.7%), narcotic related complications were not different between the two groups. No difference in duration of hospital stay or ICU stay could be demonstrated. We conclude that ITM provides better pain relief, without more serious complications, than PCA nalbuphine. We recommend it as a safe, effective technique to treat postoperative pain in children following thoracic or upper abdominal procedures.

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“…The ideal concentration of caudal bupivacaine to provide adequate analgesia is between 0.125 and 0.175% [2,3]. Morphine [4][5][6][7][8][9] and clonidine [10][11][12][13][14][15][16][17] have been added to local anesthetics in an attempt to improve the duration and quality of caudal block analgesia. Unfortunately, these agents have potential side effects that can limit their use [11,14,18,19].…”

Section: Introductionmentioning

confidence: 99%