Adenotonsillectomy in children: a comparison of morphine and fentanyl for peri-operative analgesia

This study compared the effectiveness and side-effects of intra-operative f entanyl with fentanyl and morphine for elective adenotonsillectomy in a dou ble-blind study, in 60 children randomly allocated to receive either intrav enous fentanyl 1 mug.kg(-1) intra-operatively or intramuscular morphine 100 mug.kg(-1) at induction. All children received a standard anaesthetic indu ction with intravenous fentanyl 1 mug.kg(-1) and propofol 4-5 mg.kg(-1) and maintenance with oxygen, nitrous ox:ide and isoflurane. Pain scores, emeti c episodes and supplemental morphine requirements were recorded for 24 h po stoperatively. The overall incidence of postoperative vomiting was high in both groups: 70% in the fentanyl group and 78% in the morphine group. The i ncidence of postoperative vomiting was lower in the fentanyl group (p < 0.0 3) in the first 4 h, but similar by 24 h. Children who received morphine at any time in the first 24 h had more median (range) episodes of vomiting [2 (0-7)] than children receiving fentanyl only [1 (0-3); p < 0.03]. Administ ration of rescue anti-emetics, pain scores in recovery and pain scores over the next 24 h were similar between the two groups.