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LETTER TO THE EDITOR

Small-Dose Epidural Morphine

Department of Anesthesiology; The University of Mississippi Medical Center; Jackson, Mississippi; JMayhew{at}anesthesia.umsmed.edu

To the Editor:

A recent paper by Vetter et al. (1) comparing the effects of a single dose of caudally administered morphine, clonidine, or hydromorphone, each in combination with ropivacaine, in children after ureteral implant surgery found similar pain scores but a lesser incidence of side effects with clonidine. They state in their discussion that a smaller dose of caudal morphine may result in fewer side effects and, referencing my study (wherein 30–40 µg/kg of morphine was used) (2), state that such studies included less painful surgery. However, my study did show that we had fewer side effects but similar duration of painless times as occurred in studies with larger doses of epidural morphine. A more recent study demonstrated similar painless hours as our study but with even smaller doses of morphine (10–20 µg/kg) (3,4). It would appear that equivalent pain relief using less morphine may be achieved with fewer side effects than those seen by the authors in their current study.

Footnotes

Dr. Vetter does not wish to respond.

REFERENCES

1. Vetter TR, Carvallo D, Johnson JL, Mazurek MS, Presson RG Jr. A comparison of single-dose caudal clonidine, morphine or hydromorphone combined with ropivacaine in pediatric patients undergoing ureteral reimplantation. Anesth Analg 2007;104:1356–63[Abstract/Free Full Text]
2. Mayhew JF, Brodsky RC, Blakey D. Petersen W. Low-dose caudal morphine for postoperative analgesia in infants and children: a report of 500 cases. J Clin Anesth 1995;7:640–2[Web of Science][Medline]
3. Castillo-Zamara C, Castillo-Percalta JA, Nava-Ocampo AA. Dose minimization study of single dose epidural morphine in patients undergoing hip surgery under regional anesthesia with bupivacaine. Pediatric Anesth 2005;15:29–36
4. Mayhew J, Siddiqui S. Very low dose caudal morphine. Pediatric Anesth 2005;15:623

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