Effectiveness of morphine via thoracic epidural vs intravenous infusion on postthoracotomy pain and stress response in children

Background:Thoracotomy causes severe pain in the postoperative period. The aim was to evaluate effectiveness of two pain treatment methods with morphine on postthoracotomy pain and stress response. Methods: Thirty-two children undergoing major thoracotomy for noncardiac thoracic surgery were allocated to receive either single dose of thoracic epidural morphine 0.1 mg.kg(-1) in 0.2 ml.kg(-1) saline (TEP group, n = 16) or morphine infusion at 0.02 mg.kg(-1) h(-1) (INF group, n = 16) following bolus dose of 0.05 mg.kg(-1) postinduction. Pain and sedation scores and incidence of complications were recorded for 24 h and cortisol, blood glucose, insulin and morphine serum levels were evaluated following induction, 1, 8, 12, and 24 h after initial morphine administration. Results: Five patients in TEP and one in INF required rescue morphine. The cortisol, insulin and blood glucose increased during the study and returned to normal levels at 24th hour (P < 0.05), similarly in both groups (P > 0.05). The morphine levels were variable within and between groups (P < 0.05). A common complication was nausea and vomiting with both the techniques (P > 0.05). Conclusion: Single dose TEP morphine offers no advantage over INF for pain treatment for thoracotomy in children and neither technique provided suppression of stress hormones in the first 24 h postoperatively.