Morphine with or without a local anaesthetic for postoperative intrathecalpain treatment after selective dorsal rhizotomy in children

Selective dorsal rhizotomy is a surgical procedure with a selective divisio n of posterior spinal nerve rootlets to treat spasticity in children. The e xtensive surgical procedure with multilevel laminectomies and the nerve roo t manipulation result in intense pain postoperatively. Two intrathecal (IT) regimes of pain treatment were compared in these children, concerning thei r pain relief and possible side-effects. In a prospective study, 12 childre n (3-6 years of age) with six in each group, received either intermittent I T morphine (5 mug.kg(-1) four times a day) or continuous infusion of a mixt ure of bupivacaine (40 mug.kg(-1).h(-1)) and morphine (0.6 mug.kg(-1).h(-1) ). Pain score was lower in the bupivacaine/morphine group (0.2 +/- 1.1) com pared to intermittent morphine (2 +/- 2.4) on a scale from 0 to 6 (P less t han or equal to 0.0001). Bupivacaine/morphine resulted in a lower, but not significant, difference in pruritus and lower muscle spasm. Haemodynamic an d ventilatory parameters did not differ between the groups. Intrathecal con tinuous infusion of bupivacaine and morphine was superior to intermittent m orphine in the treatment of pain after selective dorsal rhizotomy operation s.