Postoperative analgesia in children: A comparison of three different doses of caudal epidural morphine.
OBJECTIVE
Caudal epidural block is the most commonly used neuraxial block in children. Morphine has been used as a caudal additive for more than three decades. The aim of our study was to evaluate the efficacy and duration of analgesia of three different doses of caudal epidural morphine (CEM), and to find out the incidence of side effects.


METHODS
This study was conducted on 75 patients of American Society of Anesthesiologists grades I and II, aged 2-12 years, undergoing lower abdominal and urogenital surgeries. Patients were randomly allocated to one of the three groups according to the dose of morphine. Group I received 30 μg/kg, group II 50 μg/kg, and group III 70 μg/kg. Heart rate, blood pressure, oxygen saturation, electrocardiogram, pain score, sedation score, duration of analgesia, and side-effects were noted.


RESULTS
The mean duration of analgesia was 8.63 h in group I, 13.36 h in group II and 19.19 h in group III. Respiratory depression was noted in three patients in group III. One patient in group I had itching. One patient each in groups I, II, and III had nausea/vomiting.


CONCLUSIONS
CEM significantly prolongs the duration of analgesia, though with a higher dose the risk of respiratory depression should always be kept in mind.
Department of Anesthesiology and Critical Care, Safdarjung Hospital, New Delhi, India.
Neha
N
Baduni
Department of Cardiothoracic Anesthesia, Freeman Hospital, Newcastle Upon Tyne, United Kingdom.
Manoj Kumar
MK
Sanwal
Department of Anesthesiology and Critical Care, Hamdard Institute of Medical Sciences and Research, New Delhi, India.
Homay
H
Vajifdar
Department of Anesthesiology and Critical Care, Lady Hardinge Medical College and Associted Hospitals, New Delhi, India.
Radhika
R
Agarwala
Analgesia; caudal; morphine; pediatric; respiratory depression