British Journal of Anaesthesia, 2001, Vol. 87, No. 3 390-399
© 2001 The Board of Management and Trustees of the British Journal of Anaesthesia
Clinical Investigations |
Hormonal and metabolic stress responses after major surgery in children aged 0–3 years: a double-blind, randomized trial comparing the effects of continuous versus intermittent morphine
1Department of Anaesthesiology and 2Paediatric Surgery, Sophia Children’s Hospital, University Hospital Rotterdam, Dr Molewaterplein 60, 3015 GJ Rotterdam, The Netherlands. 3Department of Paediatrics, Critical Care Medicine Section, Arkansas Children’s Hospital, University of Arkansas for Medical Sciences, Little Rock, AR, USA. 4Department of Medical Psychology and Psychotherapy, Erasmus University, Rotterdam, The Netherlands. 5Department of Epidemiology and Biostatistics, Erasmus University, Rotterdam, The Netherlands. 6Department of Internal Medicine, University Hospital, Rotterdam, The Netherlands*Corresponding author
Presented in part at the 2000 APA meeting, Birmingham, UK.
Children aged 0–3 yr were stratified for age and randomized to receive either continuous morphine (CM, 10 µg kg–1 h–1) with three-hourly placebo boluses or intermittent morphine (IM, 30 µg kg–1 every 3 h) with a placebo infusion for postoperative analgesia. Plasma concentrations of epinephrine, norepinephrine, insulin, glucose and lactate were measured before and at the end of surgery and 6, 12 and 24 h after surgery. Pain was assessed with validated pain scales [the COMFORT scale and a visual analogue scale (VAS)] with the availability of additional morphine doses. Minor differences occurred between the randomized treatment groups, the oldest IM group (aged 1–3 yr) having a higher blood glucose concentration (P=0.003), mean arterial pressure (P=0.02) and COMFORT score (P=0.02) than the CM group. In the neonates, preoperative plasma concentrations of norepinephrine (P=0.01) and lactate (P<0.001) were significantly higher, while the postoperative plasma concentrations of epinephrine were significantly lower (P<0.001) and plasma concentrations of insulin significantly higher (P<0.005) than in the older age groups. Postoperative pain scores (P<0.003) and morphine consumption (P<0.001) were significantly lower in the neonates than in the older age groups. Our results show that continuous infusion of morphine does not provide any major advantages over intermittent morphine boluses for postoperative analgesia in neonates and infants.
Br J Anaesth 2001; 87: 390–9
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