title: Perception of pain following rectal administration of morphine in children: a comparison of a gel and a solution.
abstract: BACKGROUND
  Rectal administration of morphine is one possible route of delivery in children. The aim of this study was to determine the pain experience during rectal administration of two different morphine preparations.
  
  
  METHODS
  The acceptance of the pain of rectal administration of morphine for premedication was studied in 120 children. Children were randomized to receive either morphine solution in saline (0.2 mg.kg(-1), 1 mg.ml(-1)) or morphine gel (0.2 mg.kg(-1), 1 mg.ml(-1)) with an adjusted pH for rectal use in a double-blind fashion. Children were stratified into three groups according to age (1-2, 3-6, and 7-10 years). Pain was assessed with the Children's Hospital of Eastern Ontario Pain Scale, the McGrath Facial Affective Scale, or the visual analogue scale, depending on the age group.
  
  
  RESULTS
  The overall pain scores in all age groups were low. Children aged 1-2 years (P < 0.01) and 3-6 years (P < 0.05) had significantly less pain when morphine was administered as a gel than a solution. The difference in pain experience between the two forms was not significant in the age group of 7-10 years.
  
  
  CONCLUSIONS
  The results indicate that most of the children tolerated rectal administration of morphine well in terms of pain experience, in both gel and solution form. The morphine gel, intended for rectal use appears to be the preparation of choice in children aged 1-6 years.
authors.affiliation: Department of Paediatric Anaesthesia and Intensive Care, Pain Treatment Service, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden. stefan.lundeberg@karolinska.se
authors.forename: Stefan
authors.initials: S
authors.lastname: Lundeberg
authors.forename: Pirkko
authors.initials: P
authors.lastname: Hatava
authors.forename: Michael
authors.initials: M
authors.lastname: Lagerkranser
authors.forename: Gunnar L
authors.initials: GL
authors.lastname: Olsson
mesh_terms: D000285:Administration, Rectal; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005782:Gels / Q000008:administration & dosage; D006801:Humans; D007223:Infant; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects*; D010146:Pain / Q000139:chemically induced* / Q000523:psychology*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010465:Perception / Q000502:physiology*; D012016:Reference Values; D012996:Solutions / Q000008:administration & dosage
chemical_list: D000701:Analgesics, Opioid; D005782:Gels; D012996:Solutions; D009020:Morphine