NM-328
Intrathecal Clonidine Versus Intrathecal Morphine for Postoperative Analgesia in Pediatric Urologic Procedures
Ellingboe M, Klein M, Patel N, Ross P, Cucchiaro G, Costandi A
Children's Hospital of Los Angeles, Los Angeles, California, United states
Background: There is no data currently in the literature on the efficacy and safety of intrathecal clonidine for post-operative pain management in children. We evaluated the efficacy and safety profile of 1mcg/kg intrathecal clonidine (IC) versus 5mcg/kg intrathecal morphine (IM) for postoperative pain management in children undergoing urologic procedures.
Methods: We reviewed the pain management service database and the electronic medical records of patients who received IC or IM for postoperative analgesia for urologic procedures between March 2013 and June 2017 in children under 13 years of age. Patients had been prospectively followed for 24 hours after the intrathecal medication administration.
Results: The medical records of 97 patients were examined. In the PACU, IC group had statistically significantly higher average pain scores (4 ± 2.9) compared to the IM group (1.4 ± 2.1) (p=0.001). The average pain scores on the floor for IC group (2.2 ± 1.2) were also significantly higher than the average pain scores for the IM group (1.2 ± 0.7) (p=0.001).
The opioid usage (reported in mg/kg of morphine equivalents) following PACU discharge over the first 24 hours post-operatively was 0.06 ± 0.06 for the IC group compared to 0.08 ± 0.08 for the IM group, however this was not statistically significant (p=0.14).
The IM group experienced a statistically significant increased incidence of nausea and vomiting on the floor 41% compared to the IC group 18% (p=0.013) as well as significantly increased incidence of pruritus in the first 24 hours following discharge from PACU (32% versus 0%).
Four patients in the IC group (7.2%) experienced brief episodes of bradycardia in the first 24 hours post-operatively that resolved spontaneously versus two patients in the IM group (4.9%). Two patients in the IM group (4.9%) required supplemental oxygen after being discharged from the PACU to manage episodes of hypoxemia. No severe respiratory depression requiring assisted ventilation or naloxone administration was observed.
Conclusion: Intrathecal clonidine appears to be a safe and effective alternative to intrathecal morphine in controlling post-operative pain following pediatric urologic procedures. Although the difference in pain scores between intrathecal clonidine and morphine may be statistically different, this difference is not clinically relevant. In conclusion, intrathecal clonidine provides adequate analgesia with significantly fewer side effects compared to intrathecal morphine.
References:
Ganesh A, Kim A, Casale P, Cucchiaro G. Low-dose intrathecal morphine for postoperative analgesia in children. Anesth Analg. 2007 Feb; 104 (2): 271-6.
Vetter, Thomas R. MD; Carvallo, Daniel MD; Johnson, Jodie L. MD; Mazurek, Michael S. MD; Presson, Robert G. Jr MD. A Comparison of Single-Dose Caudal Clonidine, Morphine, or Hydromorphone Combined with Ropivacaine in Pediatric Patients Undergoing Ureteral Reimplantation. Anesthesia & Analgesia: 2007 June; 104 (6): 1356-1363.
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