TREATMENT OF POSTOPERATIVE PAIN WITH MORPHINE HYDROCHLORIDE IN CHILDREN UNDER SIX YEARS OF AGE IN GENERAL HOSPITAL WARDS

Abstract

Introduction and Objectives: Orthopaedic surgery is associated with significant pain in the immediate postoperative period. Management of this pain often requires the administration of opiates. The goal of this study is to evaluate the efficacy of analgaesic treatment with intravenous morphine hydrochloride in a nurse-controlled analgaesia (NCA) system during the first day postoperative in children in general hospital wards.

Materials and Methods: The study included 69 consecutive patients, all under 6 years of age, who underwent scheduled orthopedic surgery. All patients were treated postoperatively using intravenous morphine hydrochloride using the NCA system according to the following protocol: loading dose: 50–100 μg/kg; continuous infusion: 10–20 μg/kg/h; bolus dosage: 4- μg/kg: closure time: 20”; maximum dose: 400 μg/kg/4h. The following variables were evaluated: 1). Intensity of pain: none = 0 / mild = 1 / moderate = 2 / very intense = 3; 2). Side effects: a) nausea and vomiting: none =0 / 1 episode in 4 hours = 1 / more than 1 episode in 4 hours = 2. b) Urinary retention: none = 0 / spontaneous micturition after less than 8 h = 1/ draining catheter required = 2; 3). Average morphine chloride dose/kg of weight.

Results: Average age was 24.3 months (range: 4 months – 6 years). Average weight: 12.7 kg. Results showed no case of excessive sedation or respiratory depression. Average morphine hydrochloride dosage per kg body weight was 365.5 μg (± 402.5 μg).

Discussion and Conclusions: The guidelines of our I.V. morphine hydrochloride protocol for NCA yielded satisfactory control of post-operative pain after trauma surgery in children under 6 years old. No major side effects were noted in our patients, and the protocol may be safely used.