Characteristics and adequacy of intravenous morphine infusions in children in a paediatric oncology setting.

Abstract

Pain management is central in the care of patients in paediatric oncology. Intravenous (i.v.) morphine infusion is an important treatment modality. The objectives of this study were to identify the characteristics of children who receive i.v. morphine infusions in a paediatric oncology setting and to describe the effectiveness, tolerability, and limiting side-effects of this treatment. We prospectively collected evaluation charts for all morphine infusions in a paediatric oncology unit during a 4-year period, and reviewed the medical records of the patients. The incidence of breakthrough pain was used as a measure of the effectiveness of morphine treatment. For comparison, patients were grouped according to causes of pain; minor surgery, major surgery, tumour/disease, or treatment side-effects. Overall, 72 individuals (36% of all 201 patients diagnosed in the unit) were given morphine infusions. Patients with pain after major surgery suffered from more breakthrough pain than the other patients during the 1st day of morphine treatment even though their morphine consumption was almost twice as high (0.64 vs. 0.36 mg/kg, P < 0.001); 92% of these patients had solid tumours. Common morphine side-effects were vomiting (38%), nausea (32%), and constipation (24%). Patients who undergo major tumour surgery require extensive pain management to achieve acceptable post-operative pain relief. The routine of giving both a bolus dose and increasing the morphine dose at breakthrough pain should be encouraged. For the other patients studied, morphine infusions were considered to be adequate, but vomiting, nausea, and constipation might be reduced if prophylactic antiemetics and laxatives were given.