Efficacy and complications of morphine infusions in postoperative paediatric patients

Efficacy and complications of morphine infusions in postoperative paediatric patients

Esmail Z; Montgomery C; Courtrn C; Hamilton D; Kestle J

Paediatric Anaesthesia

1999

Child; Female; Humans; Male; Pain; Analgesics; Follow-Up Studies; Confidence Intervals; Incidence; Acute Disease; adolescent; Preschool; infant; retrospective studies; Infusions; Intravenous; Opioid/administration & dosage/adverse effects/therapeutic use; Morphine/administration & dosage/adverse effects/therapeutic use; Postoperative/prevention & control; Respiration/drug effects; Akathisia; Analgesia/nursing; Anesthesia Recovery Period; Anoxemia/chemically induced; Arousal/drug effects; Drug-Induced/etiology; Postoperative Nausea and Vomiting/chemically induced; Pruritus/chemically induced; Urinary Retention/chemically induced

The aim of the study was to evaluate the efficacy and the incidence of clinically significant adverse drug reactions (ADRs) in paediatric patients receiving continuous intravenous morphine infusions for acute postoperative pain. Definitions were established for ADRs and data were collected in an immediately retrospective fashion for a maximum of 72 h in 110 patients >/=5 three months of age (0.3-16.7 years) receiving morphine infusions and admitted to a general ward over a three month convenience sampling period. Inadequate analgesia occurred in 65.5% of patients during the first 24 h of therapy and occurred most frequently in patients with infusion rates of 20 microg.kg-1.h-1 or less. Nausea/vomiting was the most commonly experienced ADR (42.5%). The incidence of respiratory depression was 0% (95% CI=0-3.3%). Other ADRs included: urinary retention (13.5%), pruritus (12.7%), dysphoria (7.3%), hypoxaemia (4.5%), discontinuation of morphine for treatment of an ADR (3.6%), and difficulty in arousal (0.9%). The most common ADRs associated with morphine infusions were inadequate analgesia (in the first 24 h) and nausea/vomiting. There were no cases of respiratory depression. Methods of avoiding initial inadequate analgesia and treating nausea and vomiting associated with morphine infusions are needed.

1999

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