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Anesth Analg 2007; 105:1170-1171
© 2007 International Anesthesia Research Society
doi: 10.1213/01.ane.0000278123.09637.b7
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LETTER TO THE EDITOR

Section Editor:
Lawrence Saidman

Pediatric Low-Dose Intrathecal Morphine May Be Different for Each Type of Surgery

Ates Duman, MD, and Seza Apiliogullari, MD

Department of Anesthesiology; Selcuk University; Konya, Turkey (Duman) Department of Anesthesiology; F. Sukan Hospital; Konya, Turkey; aduman{at}selcuk.edu.tr (Apiliogullari)

To the Editor:

A recent paper by Ganesh et al. (1) concluded that "low-dose" 4–5 µg/kg morphine in the pediatric patient can provide effective postoperative analgesia after many surgical procedures. However, we believe that this dose range is too limited. Previous studies in adults show that the optimal intrathecal morphine has a much wider range, and that the dose is dependent on the anticipated degree of postoperative pain for the type of operation. For example, the suggested effective dose of intrathecal morphine is 500 µg for knee surgery (2), whereas it is 50 µg for transurethral prostate resections (3). Pediatric "high" spinal morphine dose used for oncology, spinal surgery, cardiac surgery, and frontal encephalocele repair suggests a threefold range: from 10 to 30 µg/kg (4,5). In a recent unpublished pediatric study, we found that 2 µg/kg intrathecal morphine provides excellent postoperative analgesia in patients undergoing hypospadias repair. We therefore believe that pediatric effective "low" morphine dose needs to be determined independently for each type of surgery.

REFERENCES

  1. Ganesh A, Kim A, Casale P, Cucchiaro G. Low-dose intrathecal morphine for postoperative analgesia in children. Anesth Analg 2007;104:271–6[Abstract/Free Full Text]
  2. Bowrey S, Hamer J, Bowler I, Symonds C, Hall JE. A comparison of 0.2 and 0.5 mg intrathecal morphine for postoperative analgesia after total knee replacement. Anaesthesia 2005;60:449–52[Web of Science][Medline]
  3. Sakai T, Use T, Shimamoto H, Fukano T, Sumikawa K. Mini-dose (0.05 mg) intrathecal morphine provides effective analgesia after transurethral resection of the prostate. Can J Anaesth 2003;50:1027–30[Web of Science][Medline]
  4. Tobias JD, Mateo C, Ferrer MJ, Jimenez DF, Barone CM, Reyes de Castro L. Intathecal morphine for postoperative analgesia following repair of frontal encephaloceles in children: comparison with intermittent, on-demand dosing of nalbuphine. J Clin Anesth 1997;9:280–4[Web of Science][Medline]
  5. Galloway K, Staats PS, Bowers DC. Intrathecal analgesia for children with cancer via implanted infusion pumps. Med Pediatr Oncol 2000;34:265–7[Web of Science][Medline]




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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press