Pain relief for infants undergoing abdominal surgery: comparison of infusions of i.v. morphine and extradural bupivacaine.
We have undertaken a prospective, randomized double-blind study to compare extradural bupivacaine infusions with i.v. morphine infusions for postoperative analgesia in 32 infants younger than 4 yr undergoing abdominal surgery. "Sham" extradural or i.v. catheters were used to maintain the blinded nature of the study. Both techniques provided adequate analgesia for most of the 36-h postoperative period; differences in the pattern or quality of the analgesia were not detected. Patients in the i.v. morphine group were significantly more sedated; this was accompanied by slower ventilatory frequencies (26.7 (SD 1.8) b.p.m.) compared with the extradural group (33.6 (1.3) b.p.m.). Similarly, oxygen saturation was significantly less (P < 0.01) in patients receiving morphine (medians and quartiles of 94.0 (93-96)% compared with 96.0 (93-96)%). Mean systolic arterial pressure was similar in the two groups and there were no life-threatening complications. The lack of sedation was troublesome in three patients in the extradural group.
Wolf
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Sir Humphry Davy Department of Anaesthesia, University of Bristol, Bristol Royal Hospital for Sick Children.
Hughes
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D000005:Abdomen / Q000601:surgery*; D015360:Analgesia, Epidural; D002045:Bupivacaine / Q000008:administration & dosage* / Q000627:therapeutic use; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D009020:Morphine / Q000008:administration & dosage* / Q000627:therapeutic use; D010100:Oxygen; D010149:Postoperative Pain / Q000517:prevention & control*; D011446:Prospective Studies; D012119:Respiration / Q000187:drug effects
D009020:Morphine; D010100:Oxygen; D002045:Bupivacaine