The effect of caudal vs intravenous morphine on early extubation and postoperative analgesic requirements for stage 2 and 3 single‐ventricle palliation: a double blind randomized trial

Background and Aims:Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects.Material and Methods:This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted.Results:The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting.Conclusion:CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.

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“…They concluded that CEM not only delayed the need for rescue analgesia in stage 3 patients but also made early extubation feasible. [ 11 ]…”

Section: Discussionmentioning

confidence: 99%

Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Baduni

Sanwal

Vajifdar

et al. 2016

J Anaesthesiol Clin Pharmacol

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“…In a randomized trial of infants undergoing cardiac surgery, caudal morphine and local anesthetic provided some analgesic benefits over systemic morphine, but the study had insufficient power to evaluate effects on early extubation 45 . In case series comparing perioperative neuraxial anesthesia with systemic opioid analgesia, the proportion of neonates requiring postoperative mechanical ventilation was reduced following gastrochisis repair 38 , lung resection for congenital lung lesions 46 , and Nissen fundoplication 47 .…”

Section: Clinical Benefits and Risks Of Neuraxial Analgesiamentioning

confidence: 99%

Neuraxial Analgesia in Neonates and Infants

Walker

Yaksh

2012

Anesthesia &Amp; Analgesia

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Neuraxial agents provide robust pain control, have the potential to improve outcomes, and are an important component of the perioperative care of children. Opioids or clonidine improve analgesia when added to perioperative epidural infusions; analgesia is significantly prolonged by addition of clonidine, ketamine, neostigmine or tramadol to single shot caudal injections of local anesthetic; and neonatal intrathecal anesthesia/analgesia is increasing in some centers. However, it is difficult to determine the relative risk-benefit of different techniques and drugs without detailed and sensitive data related to analgesia requirements, side-effects, and follow-up. Current data related to benefits and complications in neonates and infants are summarized, but variability in current neuraxial drug use reflects the relative lack of high quality evidence. Recent preclinical reports of adverse effects of general anesthetics on the developing brain have increased awareness of the potential benefit of neuraxial anesthesia/analgesia to avoid or reduce general anesthetic dose requirements. However, the developing spinal cord is also vulnerable to drug-related toxicity, and although there are well-established preclinical models and criteria for assessing spinal cord toxicity in adult animals, until recently there had been no systematic evaluation during early life. Therefore, the second half of this review presents preclinical data evaluating age-dependent changes in the pharmacodynamic response to different spinal analgesics, and recent studies evaluating spinal toxicity in specific developmental models. Finally, we advocate use of neuraxial agents with the widest demonstrable safety margin and suggest minimum standards for preclinical evaluation prior to adoption of new analgesics or preparations into routine clinical practice.

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“…However, the frequent dysphoria and also the QT prolongation, which results from an effect on IKr channels (139,380) and leads to an undefined risk for torsade des pointes led to a FDA mandated "black box warning" (423), which has significantly reduced the use of droperidol both for antiemetic prophylaxis and sedation. The drug still finds use in the developing world and in pediatric cardiac anesthesia in North America because of its immobilizing/sedating effects in young uncooperative children and its lack of respiratory depression per se (672,674).…”

Section: Droperidolmentioning

confidence: 99%

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

Stuth

Stucke

Zuperku

2012

Comprehensive Physiology

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This article provides a comprehensive, up to date summary of the effects of volatile, gaseous, and intravenous anesthetics and opioid agonists on ventilatory control. Emphasis is placed on data from human studies. Further mechanistic insights are provided by in vivo and in vitro data from other mammalian species. The focus is on the effects of clinically relevant agonist concentrations and studies using pharmacological, that is, supraclinical agonist concentrations are de-emphasized or excluded.

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The effect of caudal vs intravenous morphine on early extubation and postoperative analgesic requirements for stage 2 and 3 single‐ventricle palliation: a double blind randomized trial

Cited by 18 publications

References 25 publications

Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine

Neuraxial Analgesia in Neonates and Infants

Effects of Anesthetics, Sedatives, and Opioids on Ventilatory Control

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