A comparison of continuous epidural infusion and intermittent intravenous bolus doses of morphine in children undergoing selective dorsal rhizotomy

Background and Objectives. Selective dorsal rhizotomy (SDR) is associated w ith moderate to severe postoperative pain. Although the efficacy of epidura l analgesia in this population has been demonstrated, it has not been compa red with conventional intravenous (i.v.) analgesia. This prospective study compared the effects of epidural and i.e morphine regarding postoperative a nalgesia side effects, and outcomes in children following SDR. Methods. Twe nty-seven children were randomized to receive either epidural or i.v. analg esia. Children in the epidural group had a catheter placed by the neurosurg eon and received preservative-free morphine (Duramorph) 30 mu g/kg, followe d by an infusion of 3 mu/kg/h for 3 days. Children in the i.v. group receiv ed morphine 0.05-0.1 mg/kg intraoperatively, followed by 0.02 mg/kg doses p ostoperatively administered by nurses via a patient-controlled analgesia de vice. Results. The epidural group experienced lower pain scores (P = .04) a nd fewer muscle spasms (P less than or equal to .04), and tolerated activit y better (P less than or equal to .02) during the early postoperative perio d than the i.v. group. Side effects were similar between groups, with no re spiratory depression in either, group. Parents of children in both groups p erceived an adequate level of comfort and were very satisfied with the anal gesic technique. Additionally, parents believed that their child's postoper ative pain was less than anticipated (P less than or equal to .01). Conclus ions. Both techniques provided effective postoperative analgesia with a sim ilar incidence of side effects; however, our findings,suggest that continuo us infusions of epidural morphine improved overall comfort with lower pain scores, fewer muscle spasms, and improved tolerance of activity during the initial postoperative period.