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Dose minimization study of single‐dose epidural morphine in patients undergoing hip surgery under regional anesthesia with bupivacaine
Author(s) -
CastilloZamora Carlos,
CastilloPeralta Luz Antonia,
NavaOcampo Alejandro A.
Publication year - 2005
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.1460-9592.2004.01391.x
Subject(s) - medicine , anesthesia , bupivacaine , morphine , vomiting , analgesic , sedation , urinary retention , surgery , nausea , adverse effect , epidural space
Summary Background : In order to decrease the rate of adverse effects, we aimed to identify the lowest analgesic dose of epidural morphine administered to patients undergoing hip surgery. Methods : Forty‐five ASA I‐II children undergoing surgical correction of hip dysplasia under caudal or epidural anesthesia with bupivacaine were randomized to receive epidural morphine 11.2, 15 or 20 μ g·kg −1 (groups 1, 2 and 3, respectively; 15 patients per group) immediately after completion of surgery. Postoperative pain control, sedation, motor block, urinary retention, pruritus and vomiting were evaluated. Results : In the recovery room, 46.7% of patients from group 1, 33.3% from group 2, and 93.3% from group 3 were sleeping but were easy to arouse ( x 2 = 12.2; P < 0.005). The rest of the patients from each respective group were completely asleep. The cardiovascular and respiratory parameters were within normal limits. The ability to move the legs returned approximately 1 h after surgery in all three groups. Seven patients (46.7%) from group 1, nine (60%) from group 2, and 13 patients (86.7%) from group 3 vomited ( x 2 = 5.4; P = 0.06). One patient receiving 20 μ g·kg −1 morphine experienced urinary retention. One patient receiving 15 μ g·kg −1 morphine suffered from pruritus. The duration of analgesia was similar, 12–14 h, in all three groups. Conclusions : In patients undergoing hip surgery under regional anesthesia with bupivacaine, epidural morphine at a dose of 11.2 μ g·kg −1 administered immediately after completion of the procedure resulted in adequate pain relief for more than 12 h. Explanation of the high rate of patients vomiting (>45%) remains to be elucidated.