title: The effects of different doses of caudal morphine with levobupivacaine on postoperative vomiting and quality of analgesia after circumcision.
abstract: The study aim was to investigate the effect of three different morphine doses added to levobupivacaine 0.125% for caudal analgesia after circumcision surgery in children, particularly in relation to the frequency of postoperative vomiting within the first 24 hours following surgery. Two hundred and forty patients aged 5 to 12 years undergoing circumcision were included in the study. Following induction, caudal 0.125% levobupivacaine 0.5 ml/kg was given after adding 7.5, 10 or 15 µg/kg morphine. The postoperative incidence of vomiting was 5%, 12.5% and 17.5% in the groups 7.5, 10 and 15 µg/kg morphine, respectively (P=0.012, 7.5 versus 15 µg/kg groups). Five percent of the 7.5 µg/kg group and none of the patients in the other groups required paracetamol within the first 12 hours, and there was a significantly greater need for rescue paracetamol over the 24 hours in the 7.5 group versus the 15 µg/kg group (P=0.013). Postoperative analgesic durations were long and did not differ between groups (1273±338, 1361±192 and 1426±48 minutes, respectively, P=0.08). In conclusion, because the incidence of vomiting is very low, the duration of postoperative analgesia is long and a dose of 7.5 µg/kg caudal morphine is much lower than doses previously reported to be associated with respiratory depression, this study supports the use of 7.5 µg/kg caudal morphine added to 0.125% levobupivacaine for circumcision surgery.
authors.affiliation: Department of Anesthesiology and Reanimation, Ataturk University School of Medicine, Erzurum, Turkey.
authors.forename: A
authors.initials: A
authors.lastname: Dostbil
authors.forename: M
authors.initials: M
authors.lastname: Gursac Celik
authors.forename: M
authors.initials: M
authors.lastname: Aksoy
authors.forename: A
authors.initials: A
authors.lastname: Ahiskalioglu
authors.forename: E C
authors.initials: EC
authors.lastname: Celik
authors.forename: H A
authors.initials: HA
authors.lastname: Alici
authors.forename: I
authors.initials: I
authors.lastname: Ozbey
mesh_terms: D000701:Analgesics, Opioid / Q000008:administration & dosage*; D000763:Anesthesia, Caudal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D002648:Child; D002944:Circumcision, Male; D004311:Double-Blind Method; D006801:Humans; D000077554:Levobupivacaine; D008297:Male; D009020:Morphine / Q000008:administration & dosage* / Q000009:adverse effects; D010149:Postoperative Pain / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D009020:Morphine; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: caudal analgesia; circumcision; morphine