Author(s)

Alaa Ali M. Elzohry^*, Sahar Abdel-Baky Mohamed, Khaled M. Fares, Montaser A. Mohamed, Ahmad M. Abd El-Rahman, Mohamad Farouk Mohamad

ICU and Pain Management, South Egypt Cancer Institute, Assiut University, Assiut, Egypt.

Background: Pediatric patients have remained undertreated for postoperative pain because of the difficulty of pain assessment and apprehension. Intrathecal opioids—including morphine—have become a popular method for providing post-operative analgesia in children. Objectives: To compare different doses of morphine via intrathecal route (2 μg/kg, 5 μg/kg, and 10 μg/kg) for post-operative analgesia in pediatric patients following for abdominal neuroblastoma surgery. Methods: This randomized, double-blinded, study was approved by local ethics committee of South Egypt Cancer Institute, Assiut University, Assiut—Egypt, and registered at https://www.clinicaltrials.gov/ at no.: “NCT03158584”. Forty-five patients scheduled for surgical excision of abdominal neuroblastoma were divided into 3 groups (15 patients each); group (I): received intrathecal morphine 2 μg/kg added to normal saline (3 mL volume). Group (II): received intrathecal morphine 5 μg/kg. Group (III): received intrathecal morphine 10 μg/kg. Intra-, and post-operative hemodynamics, FLACC score, time to first request of rescue analgesia, total analgesic consumption, and side effects were recorded for 24 hours. Results: there was a significant reduction in FLACC score in groups II and III starting immediately till 24 hours postoperatively compared to group I (P < 0.05). None of the patients in groups II and III (n = 15 each), while all the patients in group I (n = 15) required postoperative rescue analgesia. In group (I), time to first request of rescue analgesia, cumulative perfalgan, and fentanyl consumptions were 5.47 ± 1.60 hours, 613 ± 182.92 mg, and 10.37 ± 3.78 μg respectively. There was no significant difference among groups regarding postoperative sedation (P > 0.05). No significant difference was observed between groups in side effects. Conclusions: 5 μg/kg of IT morphine achieved a reasonable balance between postoperative analgesia, and the incidence of side effects in pediatric patients following major abdominal cancer surgeries.

Morphine, Intrathecal Route, Abdominal Neuroblastoma, FLACC Score, Acute Pain

Elzohry, A. , Mohamed, S. , Fares, K. , Mohamed, M. , Abd El-Rahman, A. and Farouk Mohamad, M. (2022) Safety and Efficacy of Intrathecal Morphine in Children Undergoing Surgery for Abdominal Neuroblastoma. Dose Finding, Randomized, Clinical Study. Open Journal of Anesthesiology, 12, 368-378. doi: 10.4236/ojanes.2022.1212032.