Author(s): Sunitha K. S1 , Manukumar H2

BACKGROUND: Use of Intrathecal morphine for postoperative analgesia in paediatric patients is in clinical practice1 . The dose ranges from 2-5 mcg/kg body weight. 2, 3 The duration of analgesia depends on the type of surgery1, 2 (12-36 hours). We evaluated the efficacy & safety profile of low-dose intrathecal morphine (3-4 mcg/kg) for postoperative pain management after various surgical procedures in children. METHODS: In our prospective observational clinical study, intrathecal morphine, 3-4 mcg/kg was injected at the conclusion of surgery, before extubation in 40 children undergoing various surgical procedures at VIMS & RC, Bangalore. Pain assessment was done from immediate postoperative period on an hourly basis till the patient required a rescue analgesic using FLACC Score. Vital parameters were also monitored. A FLACC Score of >5 was considered the time for initiation of rescue analgesic. All these children received 8th hourly Inj. Ondansetron, 0.1mg/kg to counteract the nausea & vomiting potential of morphine. RESULTS: The statistical analysis of results was done using descriptive and inferential analysis. The analgesic duration (from immediate postoperative period to rescue analgesic dose) ranged from 12-24 hours, with most patients having analgesia between 18 to 22 hours (60%). There was no incidence of side effects like nausea & vomiting, pruritus, respiratory depression, PDPH. We were unable to assess urinary retention as all children were catheterised preoperatively in view of the surgical procedure & continued till initiation of rescue analgesic. CONCLUSION: We conclude that low-dose intrathecal morphine (3-4 mcg/kg) for surgical procedures in paediatric patients provide intense, safe, prolonged postoperative analgesia.

Global Tech Summit