title: Adenotonsillectomy in children: a comparison of morphine and fentanyl for peri-operative analgesia.
abstract: This study compared the effectiveness and side-effects of intra-operative fentanyl with fentanyl and morphine for elective adenotonsillectomy in a double-blind study, in 60 children randomly allocated to receive either intravenous fentanyl 1 microg x kg(-1) intra-operatively or intramuscular morphine 100 microg x kg(-1) at induction. All children received a standard anaesthetic induction with intravenous fentanyl 1 microg x kg(-1) and propofol 4-5 mg x kg(-1) and maintenance with oxygen, nitrous oxide and isoflurane. Pain scores, emetic episodes and supplemental morphine requirements were recorded for 24 h postoperatively. The overall incidence of postoperative vomiting was high in both groups: 70% in the fentanyl group and 78% in the morphine group. The incidence of postoperative vomiting was lower in the fentanyl group (p < 0.03) in the first 4 h, but similar by 24 h. Children who received morphine at any time in the first 24 h had more median (range) episodes of vomiting [2 (0-7)] than children receiving fentanyl only [l (0-3); p < 0.03]. Administration of rescue anti-emetics, pain scores in recovery and pain scores over the next 24 h were similar between the two groups.
authors.affiliation: Derriford Hospital, Plymouth PL6 8DH, UK.
authors.forename: K
authors.initials: K
authors.lastname: Mukherjee
authors.forename: V
authors.initials: V
authors.lastname: Esuvaranathan
authors.forename: C
authors.initials: C
authors.lastname: Streets
authors.forename: A
authors.initials: A
authors.lastname: Johnson
authors.forename: A S
authors.initials: AS
authors.lastname: Carr
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D000932:Antiemetics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D005283:Fentanyl / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000139:chemically induced; D014068:Tonsillectomy
chemical_list: D000701:Analgesics, Opioid; D000932:Antiemetics; D009020:Morphine; D005283:Fentanyl