title: Intrathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine.
abstract: OBJECTIVE
  To determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles.
  
  
  METHODS
  Prospective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort.
  
  
  METHODS
  Metropolitan hospital in the Philippines.
  
  
  METHODS
  24 ASA physical status I and II children undergoing frontal encephalocele repair.
  
  
  METHODS
  Following induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. 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).
  
  
  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 1 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.
  
  
  CONCLUSIONS
  Lumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.
authors.affiliation: Department of Child Health Anesthesiology, University of Missouri, Columbia, MO 65212, USA.
authors.forename: J D
authors.initials: JD
authors.lastname: Tobias
authors.forename: C
authors.initials: C
authors.lastname: Mateo
authors.forename: M J
authors.initials: MJ
authors.lastname: Ferrer
authors.forename: D F
authors.initials: DF
authors.lastname: Jimenez
authors.forename: C M
authors.initials: CM
authors.lastname: Barone
authors.forename: L
authors.initials: L
authors.lastname: Reyes de Castro
mesh_terms: D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004677:Encephalocele / Q000601:surgery*; D005260:Female; D005625:Frontal Lobe / Q000601:surgery*; D006801:Humans; D007275:Injections, Intravenous; D007278:Injections, Spinal; D008297:Male; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D009266:Nalbuphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D011446:Prospective Studies; D012189:Retrospective Studies
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine; D009266:Nalbuphine