Effectiveness of morphine via thoracic epidural vs intravenous infusion on postthoracotomy pain and stress response in children.
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 x kg(-1) in 0.2 ml x kg(-1) saline (TEP group, n = 16) or morphine infusion at 0.02 mg x kg(-1) h(-1) (INF group, n = 16) following bolus dose of 0.05 mg x 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).


CONCLUSIONS
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.
Department of Anaesthesiology, Istanbul University, Cerrahpaşa Medical Faculty, Istanbul, Turkey. apbs@istanbul.edu.tr
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Bahar
D000293:Adolescent; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D001786:Blood Glucose / Q000187:drug effects; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D007262:Infusions, Intravenous; D007328:Insulin / Q000097:blood; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000097:blood / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000517:prevention & control*; D013312:Stress, Physiological / Q000097:blood*; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D001786:Blood Glucose; D007328:Insulin; D009020:Morphine; D006854:Hydrocortisone