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Morphine After Tonsillectomy Could be Life-Threatening for Children

Jan 30, 2015

Morphine to treat post-operative pain in children who have had their tonsils removed could lead to potentially life-threatening respiratory problems, according to a new study.

The effects of morphine were so severe that the study's Drug Safety Monitoring Board halted the study period early, Medical News Today reports. The study showed that ibuprofen is a safe and effective alternative to morphine. Study co-author Dr. Doron Sommer said, "These results should prompt clinicians to re-evaluate their post-tonsillectomy pain treatment regimen. Due to the unpredictable respiratory side-effects of morphine, its use as a first-line treatment with current dosage ranges should be discontinued for outpatient tonsillectomy."

The new study was conducted by researchers in Canada at The Hospital for Sick Children, McMaster University, and McMaster Children's Hospital. In a prospective, randomized clinical trial, 91 children, age 1-10, were to be randomly assigned post-operative painkillers to take at home following outpatient tonsillectomy surgery. The painkillers were to be prescribed from September 2012 to January 2014, according to Medical News Today. One group of participants was given standard doses of oral morphine (0.2-0.5 mg/kg) and acetaminophen (10-15 mg/kg) to take every 4 hours. The other group was given standard doses of oral ibuprofen (10 mg/kg) and acetaminophen (10-15 mg/kg) to take every 6 hours and every 4 hours respectively. Parents measured their children's oxygen saturation and any pauses in breathing using a home pulse oximeter. They were also taught how to assess the child's pain levels using the Objective Pain Scale and Faces Scale and they recorded pain levels on the first and fifth days after surgery.

Pain was effectively managed by the medication in both groups, but there was a marked difference in the frequency of oxygen desaturation incidents in which the blood's oxygen concentration falls. On the first night after surgery, 68 percent of the children receiving ibuprofen demonstrated improvement in oxygen desaturation events, Medical News Today reports. In comparison, only 14 percent of the group receiving morphine showed improvement and over time more desaturation events were recorded, up to a rate of 11to 15 events per hour. One child suffered a life-threatening adverse reaction to morphine, which included oxygen desaturation. Because of the serious respiratory risk, the researchers ended the study midway through the planned period.

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