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Effectiveness of morphine via thoracic epidural vs intravenous infusion on postthoracotomy pain and stress response in children
Author(s) -
Bozkurt Pervin,
Kaya Güner,
Yeker Yüksel,
AltIntaŞ FatiŞ,
Bakan Mefkür,
HacIbekiroǧlu Münire,
Bahar Mois
Publication year - 2004
Publication title -
pediatric anesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.704
H-Index - 82
eISSN - 1460-9592
pISSN - 1155-5645
DOI - 10.1111/j.1460-9592.2004.01278.x
Subject(s) - medicine , morphine , anesthesia , thoracotomy , bolus (digestion) , sedation , vomiting , nausea , saline , surgery
Summary Background : Thoracotomy causes severe pain in the postoperative period. The aim was to evaluate effectiveness of two pain treatment methods with morphine on postthoracotomy pain and stress response. Methods : Thirty‐two children undergoing major thoracotomy for noncardiac thoracic surgery were allocated to receive either single dose of thoracic epidural morphine 0.1 mg·kg −1 in 0.2 ml·kg −1 saline (TEP group, n = 16) or morphine infusion at 0.02 mg·kg −1 h −1 (INF group, n = 16) following bolus dose of 0.05 mg·kg −1 postinduction. Pain and sedation scores and incidence of complications were recorded for 24 h and cortisol, blood glucose, insulin and morphine serum levels were evaluated following induction, 1, 8, 12, and 24 h after initial morphine administration. Results : Five patients in TEP and one in INF required rescue morphine. The cortisol, insulin and blood glucose increased during the study and returned to normal levels at 24th hour ( P < 0.05), similarly in both groups ( P > 0.05). The morphine levels were variable within and between groups ( P < 0.05). A common complication was nausea and vomiting with both the techniques ( P > 0.05). Conclusion : Single dose TEP morphine offers no advantage over INF for pain treatment for thoracotomy in children and neither technique provided suppression of stress hormones in the first 24 h postoperatively.