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LETTER TO THE EDITOR

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

Department of Anesthesiology and Critical Care Medicine (Ganesh) The Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine; Philadelphia, Pennsylvania; ganesha{at}email.chop.edu (Cucchiaro)

In Response:

We agree with the authors (1) that different doses of morphine may be administered intrathecally. However, our study (2) simply describes our experience with the use of intrathecal morphine in a dose of 4–5 µg/kg. We have also listed the surgical procedures where this dose was administered. Larger doses of intrathecal morphine tend to have a greater incidence of side effects (3) and usually require monitoring of the patient in an intensive care unit (ICU). About 90% of the patients in our study (2) were monitored on the regular floor and the others were admitted to the ICU as per the institutional policy of admitting all neurosurgical patients to the ICU and not due to the fact that intrathecal morphine was administered. Using a uniform dose also helps to formulate the timing and dosage of rescue analgesics.

Gall et al. (3) concluded that intrathecal morphine in a dose of 5 µg/kg can be a useful adjunct in the management of postoperative pain after spine surgery (very painful) for idiopathic scoliosis.

Hypospadias surgery in our institution is almost always performed as a day surgery procedure, which makes the use of intrathecal morphine not feasible.

REFERENCES

1. Apiliogullari S, Duman A. Pediatric low-dose intrathecal morphine may be different for each type of surgery. Anesth Analg 2007;105:1170–1[Free Full Text]
2. 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]
3. Gall O, Aubineau JV, Berniere J, Desjeux L, Murat I. Analgesic effect of low-dose intrathecal morphine after spinal fusion in children. Anesthesiology 2001;94:447–52[Web of Science][Medline]

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