Effectiveness of morphine via thoracic epidural vs intravenous infusion on postthoracotomy pain and stress response in children Author(s): Bozkurt, P; Kaya, G; Yeker, Y; et al. Source: PEDIATRIC ANESTHESIA Volume: 14 Issue: 9 Pages: 748-754 DOI: 10.1111/j.1460-9592.2004.01278.x Published: SEP 2004


PEDIATRIC ANESTHESIA, vol.14, no.9, pp.748-754, 2004 (Journal Indexed in SCI)

  • Publication Type: Article / Article
  • Volume: 14 Issue: 9
  • Publication Date: 2004
  • Title of Journal : PEDIATRIC ANESTHESIA
  • Page Numbers: pp.748-754


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.