Abstract
Introduction: Pain in the postoperative period is a rising concern in paediatrics. Ideal management should be the most effective with minimal adverse effects.
Objective: Compare two regimens of analgesia, intravenous morphine, continuous infusion versus intermittent bolus in postoperative children (appendectomy).
Methods: Randomised, triple-blinded, placebo controlled study in children aged 1 month to 14 years (November 2001 to December 2003). Children were randomised in two groups: (A) morphine continuous perfusion (0,02 mg/Kg/h); (B) normal saline continuous perfusion. Both groups received bolus of morphine (0,03 mg/Kg), according to pain scale. Demographic data; duration of symptoms; surgical appendicitis staging; duration of perfusion, number of boluses; pain measurement (Faces Rating Scale), every 4 hours (first 48 hours); time until enteric feeding, first stool emission; complications and duration of hospitalization were analysed.
Results: Included 102 children (A =52;B=50). Groups were identical in age (mean years: A=9,7; B=10,1), sex, duration of symptoms before surgery (mean hours: A=40,2, B=31,8), surgical appendicitis staging. There was no statistical significant difference in: duration of perfusion (mean hours: A=26,4, B=25,8; p=0,8), number of boluses (mean: A=1,27, B=2,0; p=0,09), and pain rating. In group B, children with peritonitis showed more pain in the first 24h and needed more boluses (mean: A=0,6, B=3,7; p<0,05). There were no differences in: beginning of enteric feeding, (mean A=21 h, B=23 h; p=0,38), first stool emission (mean days: A=2,69, B=2,33; p=0,14); respiratory complications (A=0, B=0), vomiting (A=11, B=9; p=0,8), urinary retention (A=1, B=3; p=0,35) and duration of hospitalisation (mean days: A=3,74, B=3,78; p=0,9).
Conclusion: Both analgesia regimens were equally effective in the less severe appendicitis stage, without major adverse effects. In patients with peritonitis, morphine perfusion was significantly more effective in pain control.
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Abadesso, C., Nunes, S., Almeida, H. et al. 1 Pain Management: Prospective Study in Postoperative Abdominal Surgery in Children. Pediatr Res 58, 354 (2005). https://doi.org/10.1203/00006450-200508000-00030
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DOI: https://doi.org/10.1203/00006450-200508000-00030