title: Addition of morphine to local anesthetic infiltration does not improve analgesia after pediatric dental extractions.
abstract: BACKGROUND
  Opioid receptors have been noted in the peripheral nerve endings of afferent neurons. Blockade of these receptors with peripherally administered opioids is believed to result in analgesia.
  
  
  METHODS
  In a prospective, randomized, double-blind study, we studied the analgesic effects of adding a subsystemic dose of morphine to local anesthetic infiltration (lidocaine hydrochloride) during pediatric dental extractions. Forty-two subjects, aged 2-7 years of ASA physical status I-II, were randomized to receive submucous infiltration with either morphine 25 microg.kg(-1) in 2% lidocaine hydrochloride with 1 : 1 00 000 epinephrine (morphine group) or 2% lidocaine hydrochloride with 1 : 1 00 000 epinephrine (control group) at the end of surgery.
  
  
  RESULTS
  There was no difference in postoperative analgesic requirements within the first 24 h. In-hospital acetaminophen consumption was 85% in the morphine group compared with 81% in the control group.
  
  
  CONCLUSIONS
  We conclude that there is no benefit of adding a subsystemic analgesic dose of morphine to local anesthetics for analgesia after dental extractions in children.
authors.affiliation: Department of Anesthesiology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada. sbhanank@u.washington.edu
authors.forename: Sanjay M
authors.initials: SM
authors.lastname: Bhananker
authors.forename: Lawrence F
authors.initials: LF
authors.lastname: Azavedo
authors.forename: William M
authors.initials: WM
authors.lastname: Splinter
mesh_terms: D000779:Anesthetics, Local; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004357:Drug Synergism; D005260:Female; D006801:Humans; D008012:Lidocaine; D008297:Male; D009020:Morphine; D010149:Postoperative Pain / Q000188:drug therapy*; D014081:Tooth Extraction
chemical_list: D000779:Anesthetics, Local; D009020:Morphine; D008012:Lidocaine