Morphine infusions after pediatric cranial surgery: a retrospective analysis of safety and efficacy.
BACKGROUND
Morphine infusions are avoided after cranial surgery in children due to concerns of masking neurological deterioration and because cranial surgery is considered less painful than other surgical procedures. Studies indicate that up to 60% of patients experience moderate to severe pain after craniotomies. Morphine has demonstrated efficacy in the treatment of acute postoperative pain, yet codeine phosphate is commonly preferred as the standard treatment. We assessed the efficacy and safety of intravenous morphine use outside the intensive care unit (ICU) following cranial surgery in children.


METHODS
A retrospective case series analysis was conducted of medical records for 71 children. The patients underwent either cranial reconstruction (2002-2007) or supratentorial/infratentorial craniotomies (2005-2007) at British Columbia Children's Hospital. Comparison was made between patients receiving a continuous morphine infusion (CMI) and patients receiving acetaminophen and codeine. Patients were assessed for pain control and adverse events.


RESULTS
Thirty-seven children received CMI on the unit (30 cranial reconstruction and seven craniotomy), while 34 (10 cranial reconstruction and 24 craniotomy) received acetaminophen and codeine. There was no statistical difference in pain control. There was a statistically significant difference in nausea on postoperative day one (p = 0.002).


CONCLUSIONS
These findings suggest that CMI is as safe a treatment option as acetaminophen and codeine. Careful observation enables nurses to safely administer a CMI for children following cranial surgery on a surgical unit setting.
Ou
Christine H K
CH
Neurosciences & Surgery Unit, British Columbia Children's Hospital. cou@cw.bc.ca
Kent
Sarah K
SK
Hammond
Amy M
AM
Bowen-Roberts
Tim
T
Steinbok
Paul
P
Warren
Daniel T
DT
D000082:Acetaminophen / Q000627:therapeutic use; D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use*; D001955:British Columbia; D002648:Child; D002675:Child, Preschool; D003061:Codeine / Q000627:therapeutic use; D003399:Craniotomy / Q000009:adverse effects*; D016903:Drug Monitoring / Q000379:methods / Q000451:nursing; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D009020:Morphine / Q000009:adverse effects / Q000627:therapeutic use*; D009730:Nursing Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D011182:Postoperative Care / Q000379:methods / Q000451:nursing; D012189:Retrospective Studies; D012449:Safety; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000082:Acetaminophen; D009020:Morphine; D003061:Codeine