Side‐effects of postoperative epidural analgesia in children: a randomized study comparing morphine and clonidine

Cucchiaro, Giovanni; Dagher, Carole; Baujard, Catherine; Dubousset, A. M.; Benhamou, Dan

doi:10.1046/j.1460-9592.2003.01010.x

Cited by 32 publications

(23 citation statements)

References 25 publications

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“…Addition of fentanyl to bupivacaine or bupivacaine plus clonidine epidural infusions provided similar analgesia but increased side effects (Cucchiaro et al, 2006 Level II). Addition of morphine to an epidural local anaesthetic infusion was more effective than clonidine (Cucchiaro et al, 2003 Level II), but higher doses of clonidine improved analgesia when added to epidural ropivacaine infusions (De Negri et al, 2001 Level II).…”

Section: Chapter 10mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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Section: Chapter 10mentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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“…Epidural administration of clonidine or morphine plus ropivacaine was described in children who underwent various abdominal surgeries. 20 Adverse effects were evaluated during the first 48 hours after the end of surgery. Results of this trial did not include reports of respiratory depression or death.…”

Section: Resultsmentioning

confidence: 99%

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

Whittaker

2013

The Journal of Pediatric Pharmacology and Therapeutics

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BACKGROUND Pediatric patients may be at an increased risk of adverse effects from various medications. Recently, there have been a number of serious adverse events, including several pediatric patients experiencing severe respiratory depression and death as a result of the use of codeine for pain control following tonsillectomy and adenoidectomy. OBJECTIVE To assess the safety of opioid agonists in pediatric patients undergoing operative procedures or have experienced trauma and to evaluate the risk of respiratory depression and death among this population. METHODS PubMed and Medline were searched to identify randomized controlled studies from 1994 to 2012 addressing postsurgery/trauma opioid use in pediatric patients. Relative risks and confidence intervals (CIs) were calculated using data available in clinical trials. RESULTS A total of 16 clinical trials were evaluated for this review. Randomized controlled trials included studies comparing opioids versus non-opioids for a variety of painful conditions. The relative risk of respiratory depression associated with opioid use in 1 trial was 1.63 (95% CI: 0.64-6.13). The remaining 15 trials reviewed described no significant difference in respiratory depression or adverse effects associated with treatment. No deaths were attributed to opioid use in any of these studies. CONCLUSION Opioid-associated respiratory depression was very rare and no deaths were reported in the reviewed studies. These findings under the well-defined conditions of controlled studies may not be the best means of determining overall opioid-associated side effects in pediatric patients. INDEX TERMS

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Section: Resultsmentioning

confidence: 99%

“…Postoperative pain intensity was evaluated in 12 of the 14 comparisons (37,41,44,46,47,51,53,58,59,63). The pain scores or percentage of patients in pain were significantly reduced after single doses of morphine 30 μg·kg −1 preoperatively or 75 μg·kg −1 postoperatively (46,63) compared with no intervention used as control and after a constant epidural infusion of morphine 4 μg·kg −1 ·h −1 with clonidine as control (41). In three other comparisons (44,53,59), the pain scores or percentage of patients in pain were significantly higher on one or more occasions after a single preoperative dose of morphine 50 μg·kg −1 (59), or after multiple postoperative doses of 20 or 30 μg·kg −1 (44,53) compared with the active control interventions (buprenorphine, lidocaine + fentanyl and bupivacaine + fentanyl, respectively).…”

Section: Resultsmentioning

confidence: 99%

A qualitative systematic review of morphine treatment in children with postoperative pain

Duedahl

Hansen

2007

Pediatric Anesthesia

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Although several factors may justify its use as first line therapy in many parts of the world, morphine alone is not the most suitable analgesic for postoperative pain in pediatric patients, as it does not have superior analgesic effect and a higher incidence of side effects compared with active control interventions. More standardized clinical trials with multimodal regimens as well as guidelines for evaluating pediatric medicines are desirable in the future.

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Side‐effects of postoperative epidural analgesia in children: a randomized study comparing morphine and clonidine

Abstract: Epidural clonidine is followed by a significantly lower incidence of side-effects. However, its analgesic effects, at least at the doses used in this study, are less potent than those of epidural morphine.

Cited by 32 publications

References 25 publications

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Opioid Use and the Risk of Respiratory Depression and Death in the Pediatric Population

A qualitative systematic review of morphine treatment in children with postoperative pain

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