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Efficacy of a low‐dose spinal morphine with bupivacaine for postoperative analgesia in children undergoing hypospadias repair
Author(s) -
APILIOGULLARI SEZA,
DUMAN ATES,
GOK FUNDA,
AKILLIOGLU ISAK,
CIFTCI ILHAN
Publication year - 2009
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.1460-9592.2009.03136.x
Subject(s) - medicine , bupivacaine , anesthesia , hypospadias , placebo , analgesic , morphine , randomized controlled trial , surgery , alternative medicine , pathology
Summary Background: Children undergoing hypospadias repair need to be protected from highly unpleasant sensory and emotional experiences during and after surgery. We designed a double‐blinded, randomized, and placebo‐controlled study to compare the efficacy of a low‐dose (2 μg·kg −1 ) of intrathecal morphine with placebo for postoperative pain control of children undergoing repair of hypospadias surgery with spinal anesthesia. Methods: Fifty‐four children were randomly assigned to one of two spinal anesthesia groups. Group M ( n = 27) received hyperbaric bupivacaine plus 2 μg·kg −1 of preservative‐free morphine and group P ( n = 27) received hyperbaric bupivacaine plus 0.9% NaCl (placebo) under inhalation anesthesia. General anesthetics were discontinued subsequent to the block. The primary outcome was the presence of pain‐requiring analgesics during the first 12 h after the spinal block. Side effects were also recorded. The analgesic effects were evaluated by using the Children’s Hospital of Eastern Ontario Pain Scale. Results: Forty‐nine patients completed the trial. Fifteen patients (60%) in group P received supplementary analgesics within the first 12 h compared to only four patients (16.7%) in group M ( P = 0.005). Mean duration of analgesia was 480 ± 209 and 720 ± 190 min in group P and group M respectively ( P = 0.009). The groups were similar in postoperative side effects. Conclusion: Spinal anesthesia provided by hyperbaric bupivacaine is adequate for distal hypospadias repair in children, but adding 2 μg·kg −1 intrathecal morphine provides better postoperative pain control when compared to placebo in these children.