Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: Comparison with intermittent, on-demand dosing of nalbuphine

Joseph D. Tobias, Corazon Mateo, Maria Josephine R. Ferrer, David F. Jimenez, Constance M. Barone, Luisita Reyes De Castro

Research output: Contribution to journalArticle

12 Scopus citations

Abstract

Study Objective: To determine the efficacy of lumbar intrathecal (IT) morphine in a dose of 0. 02 mg/kg in providing analgesia following repair of frontal encephaloceles. Design: Prospective, open-label investigation of IT morphine with secondary comparison to a retrospective cohort. Setting: Metropolitan hospital in the Philippines. Patients: 24 ASA physical status I and 11 children undergoing frontal encephalocele repair. Interventions: Following induction of general anesthesia, IT morphine (Group 1) was administered via single-shot technique or through a lumbar IT drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2). Measurements and Main Results: Group 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 ± 9.1 hours in Group 1 and 1.6 ± 1. 2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group I required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours. Conclusion: Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.

Original languageEnglish (US)
Pages (from-to)280-284
Number of pages5
JournalJournal of Clinical Anesthesia
Volume9
Issue number4
DOIs
StatePublished - Jun 1997

Keywords

  • Analgesia
  • Anesthesia
  • Encephahlocele
  • Lumbar intrathecal
  • Morphine
  • Nalbuphine
  • Pediatrics
  • Postoperative

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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