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A Comparison of Continuous Epidural Infusion and Intermittent Intravenous Bolus Doses of Morphine in Children Undergoing Selective Dorsal Rhizotomy
  1. Shobha Malviya, M.D.,
  2. Uma A. Pandit, M.D.,
  3. Sandra Merkel, B.S.N., M.S.,
  4. Terri Voepel-Lewis, B.S.N., M.S.,
  5. Laura Zang, B.S.N., M.S.,
  6. Monica Siewert, B.A.,
  7. Alan R. Tait, Ph.D. and
  8. Karin Muraszko, M.D.
  1. From the Departments of Anesthesiology and Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan.
  1. Reprint requests: Shobha Malviya, M.D., Department of Anesthesiology, C.S. Mott Children's Hospital, F3900/Box 0211, 1500 E. Medical Center Drive, Ann Arbor, MI 48109-0211.


Background and Objectives Selective dorsal rhizotomy (SDR) is associated with moderate to severe postoperative pain. Although the efficacy of epidural analgesia in this population has been demonstrated, it has not been compared with conventional intravenous (i.v.) analgesia. This prospective study compared the effects of epidural and i.v. morphine regarding postoperative analgesia, side effects, and outcomes in children following SDR.

Methods Twenty-seven children were randomized to receive either epidural or i.v. analgesia. Children in the epidural group had a catheter placed by the neurosurgeon and received preservative-free morphine (Duramorph) 30 μg/kg, followed by an infusion of 3 μg/kg/h for 3 days. Children in the i.v. group received morphine 0.05-0.1 mg/kg intraoperatively, followed by 0.02 mg/kg doses postoperatively administered by nurses via a patient-controlled analgesia device.

Results The epidural group experienced lower pain scores (P = .04) and fewer muscle spasms (P ≤ .04), and tolerated activity better (P ≤ .02) during the early postoperative period than the i.v. group. Side effects were similar between groups, with no respiratory depression in either group. Parents of children in both groups perceived an adequate level of comfort and were very satisfied with the analgesic technique. Additionally, parents believed that their child's postoperative pain was less than anticipated (P ≤ .01).

Conclusions Both techniques provided effective postoperative analgesia with a similar incidence of side effects; however, our findings suggest that continuous infusions of epidural morphine improved overall comfort with lower pain scores, fewer muscle spasms, and improved tolerance of activity during the initial postoperative period.

  • postoperative pain
  • analgesia
  • epidural
  • morphine
  • rhizotomy
  • pediatrics

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  • This study was conducted at the C.S. Mott Children's Hospital and was supported entirely by the Department of Anesthesiology.