PEDIATRIC ANESTHESIA, vol.14, no.9, pp.748-754, 2004 (Journal Indexed in SCI)
Article / Article
Title of Journal :
Background : Thoracotomy causes severe pain in the postoperative period. The aim was to evaluate effectiveness of two pain treatment methods with morphine on postthoracotomy pain and stress response.
Methods : Thirty-two children undergoing major thoracotomy for noncardiac thoracic surgery were allocated to receive either single dose of thoracic epidural morphine 0.1 mg·kg−1 in 0.2 ml·kg−1 saline (TEP group, n = 16) or morphine infusion at 0.02 mg·kg−1 h−1 (INF group,n = 16) following bolus dose of 0.05 mg·kg−1 postinduction. Pain and sedation scores and incidence of complications were recorded for 24 h and cortisol, blood glucose, insulin and morphine serum levels were evaluated following induction, 1, 8, 12, and 24 h after initial morphine administration.
Results : Five patients in TEP and one in INF required rescue morphine. The cortisol, insulin and blood glucose increased during the study and returned to normal levels at 24th hour (P < 0.05), similarly in both groups (P > 0.05). The morphine levels were variable within and between groups (P < 0.05). A common complication was nausea and vomiting with both the techniques (P > 0.05).
Conclusion : Single dose TEP morphine offers no advantage over INF for pain treatment for thoracotomy in children and neither technique provided suppression of stress hormones in the first 24 h postoperatively.