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Safety and efficacy of continuous morphine infusions following pediatric cranial surgery in a surgical ward setting

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Abstract

Purpose

Morphine is avoided by many neurosurgeons following cranial surgery. There exists a concern regarding the potential complications and a perception that cranial surgery is less painful than other surgical procedures. At British Columbia Children’s Hospital continuous morphine infusions (CMI) have been used to control pain in pediatric neurosurgical patients. The purpose of this study was to compare the safety and efficacy of continuous intravenous morphine infusion to standard oral analgesics in a neurosurgical ward setting.

Methods

A retrospective review of medical records for 71 children was completed. The patients underwent either cranial reconstruction (2002–2007) or craniotomies for intradural pathology (2005–2007) at British Columbia Children’s Hospital. Outcome measures included pain control and adverse events. Comparison was made between patients receiving a CMI and patients receiving acetaminophen and codeine.

Results

Thirty-seven children received CMI on the ward (30 cranial reconstruction and 7 craniotomy), while 34 (10 cranial reconstruction and 24 craniotomy) received acetaminophen and codeine. There was no statistical difference in pain control. There was significantly more nausea on post-operative day one in the CMI group (p = 0.002). There were no other significant adverse events.

Conclusions

These findings suggest that CMI is comparable to acetaminophen and codeine with respect to analgesia and serious side effects. We recommend the use of CMIs as an alternative when pain is poorly controlled in post-operative pediatric neurosurgical patients to prevent the potential adverse consequences of inadequate analgesia.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada

    Daniel T. Warren

  2. Division of Pediatric Neurosurgery, Department of Surgery, University of British Columbia and British Columbia’s Children’s Hospital, Rm K3-159, 4480 Oak St., Vancouver, BC, Canada, V6H 3V4

    Tim Bowen-Roberts & Paul Steinbok

  3. Division of Neuroscience Nursing, British Columbia’s Children’s Hospital, Vancouver, BC, Canada

    Christine Ou

  4. Department of Anesthesiology, University of British Columbia and British Columbia’s Children’s Hospital, Vancouver, BC, Canada

    Robert Purdy

Authors
  1. Daniel T. Warren
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  2. Tim Bowen-Roberts
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  3. Christine Ou
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  4. Robert Purdy
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  5. Paul Steinbok
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Corresponding author

Correspondence to Paul Steinbok.

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Warren, D.T., Bowen-Roberts, T., Ou, C. et al. Safety and efficacy of continuous morphine infusions following pediatric cranial surgery in a surgical ward setting. Childs Nerv Syst 26, 1535–1541 (2010). https://doi.org/10.1007/s00381-010-1123-0

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  • DOI: https://doi.org/10.1007/s00381-010-1123-0

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