title: Predicting postoperative morphine consumption in children.
abstract: BACKGROUND
  Morphine is the most commonly used postoperative analgesic for moderate to severe pain in paediatric patients, but there is little research into predictive factors correlating with postoperative morphine consumption.
  
  
  METHODS
  All patients undergoing surgery who received morphine postoperatively over eight months were prospectively enrolled. Data analysed included total morphine consumption to day 3, age, weight, type of surgery, ASA status, preoperative opioid administration, predicted postoperative pain intensity (according to French Society of Anaesthesiology and Intensive Care classification) and surgery duration. Two cohorts were constructed: the first over 6months to construct a statistical model and the second over 2months to validate the model. ANOVA univariate analyses and multivariate linear analysis were performed.
  
  
  RESULTS
  One hundred and fifty-three patients were included in the construct cohort and 40 in the validation cohort. Multivariate analysis demonstrated that total morphine consumption through postoperative day 3 was independently increased by a decreased age, female gender, an increased duration of surgery and an increased morphine titration in PACU. Overall, the model explained 57% of morphine requirement variability. When the model was applied to the validation cohort, a significant correlation was demonstrated between observed and predicted values: r=0.67, P<0.0001.
  
  
  CONCLUSIONS
  Age, gender, duration of surgery and doses of titrated morphine in PACU proved to be strong predictors of postoperative morphine consumption by day 3 during paediatric surgery. Knowledge of such factors may help clinicians to better manage postoperative pain in children.
authors.affiliation: Department of Anaesthesia, Intensive care, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
authors.forename: Vilnis
authors.initials: V
authors.lastname: Silins
authors.affiliation: Department of Anaesthesia, Intensive care, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
authors.forename: Christopher
authors.initials: C
authors.lastname: Brasher
authors.affiliation: Department of Anaesthesia, Intensive care, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
authors.forename: Freedom
authors.initials: F
authors.lastname: Antus
authors.affiliation: Department of Anaesthesia, Intensive care, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
authors.forename: Daphné
authors.initials: D
authors.lastname: Michelet
authors.affiliation: Department of Anaesthesia, Intensive care, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France.
authors.forename: Julie
authors.initials: J
authors.lastname: Hilly
authors.affiliation: Department of Anaesthesia, Intensive Care and Perioperative Medicine, Cairns Hospital, Queensland, Australia.
authors.forename: Robert
authors.initials: R
authors.lastname: Grace
authors.affiliation: Department of Anaesthesia, Intensive care, Robert-Debré University Hospital, Paris Diderot University, Paris Sorbonne Cité, Paris, France. Electronic address: souhayl.dahmani@rdb.aphp.fr.
authors.forename: Souhayl
authors.initials: S
authors.lastname: Dahmani
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D015233:Models, Statistical; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012737:Sex Factors
chemical_list: D000701:Analgesics, Opioid; D009020:Morphine
keywords: Morphine; Paediatric; Pain; Postoperative; Surgery