Prolonged postoperative analgesia with lumbar epidural morphine in children undergoing thoracic and upper abdominal surgery

Abstract

Postoperative analgesia with lumbar epidural morphine was provided to 19 male and 7 female children (average age 11.3 years, range 3–18 years) who underwent 13 thoracic and 14 upper abdominal operations. Average duration of catheterization was 55.4 ± 28.7 h, and average time to first oral feedings 2 ± 1.5 days. Average overall time to dirst oral feedings 2 ± 2.6 days. Patients undergoing upper abdominal procedures had a significantly longer (P <0.05) time to first oral feedings and discharge home than children undergoing thoracic surgery. Average number of top-up doses of epidural morphine was 5.07 ± 2.5. Complications included: (1) pruritus in 11 patients (42%) treated medically; (2) urinary retention in 2 (8%) requiring catheterization; (3) gastrointestinal nausea and vomiting in 4 (15%), none of whom required nasogastric decompression; and (4) cardiorespiratory depression in 1 (4%). For 27 postoperative epidural analgesia procedures, 21 patients (78%) required no additional medications for pain or agitation. Four patients (15%) required diphenhydramine for agitation and sleeplessness. Three (11%) who had undergone thoracic procedures required one dose of intravenous morphine sulfate for additional pain relief in the immediate postoperative period.