INTRATHECAL MORPHINE FOR POSTOPERATIVE ANALGESIA FOLLOWING REPAIR OF FRONTAL ENCEPHALOCELES IN CHILDREN - COMPARISON WITH INTERMITTENT, ON-DEMAND DOSING OF NALBUPHINE

Study Objective: To determine the efficacy of lumbar intrathecal (IT) morphine in a dose of 0.02 mg/kg in providing analgesia following repa ir of frontal encephaloceles. Design: Prospective, open-label investig ation of IT morphine with secondary comparison to a retrospective coho rt. Setting: Metropolitan hospital in the Philippines Patients: 24 ASA physical status I and II children undergoing frontal encephalocele re pair. Interventions: Following induction of general anesthesia, IT mor phine (Group 1) was administered via single-shot technique or through a lumbar IT drain placed for cerebrospinal fluid drainage during the s urgical procedure. Postoperative analgesia was assessed by visual anal og score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age, The retrospective cohort receiv ed postoperative analgesia with intermittent doses of intravenous nalb uphine (Group 2). Measurements and Main Results: Group 1 had decreased postoperative analgesia requirements, decreased intraoperative inhala tional anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The line to the first reque st for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1 .6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 I)required) no analgesic drugs during the first 24 postoperative hou rs while all 12 patients in Group 2 (p = 0.02) did require analgesic d rugs during this period. The patients in Group 1 who did not require s upplemental analgesic drugs maintained pain scores of 2 or less throug hout the first 24 postoperative hours. Conclusion: Lumbar IT morphine provides effective analgesia following repair of frontal encephalocele s in children and adolescents. (C) 1997 by Elsevier Science Inc.