• J D Tobias, C Mateo, M J Ferrer, D F Jimenez, C M Barone, and L Reyes de Castro.
• Department of Child Health Anesthesiology, University of Missouri, Columbia, MO 65212, USA.
• J Clin Anesth. 1997 Jun 1;9(4):280-4.

Study ObjectiveTo determine the efficacy of lumbar intrathecal (i.t.) morphine in a dose of 0.02 mg/kg in providing analgesia following repair of frontal encephaloceles.DesignProspective, open-label investigation of i.t. morphine with secondary comparison to a retrospective cohort.SettingMetropolitan hospital in the Philippines.Patients24 ASA physical status I and II children undergoing frontal encephalocele repair.InterventionsFollowing induction of general anesthesia. I.t. morphine (Group 1) was administered via single-shot technique or through a lumbar i.t. drain placed for cerebrospinal fluid drainage during the surgical procedure. Postoperative analgesia was assessed by visual analog score in patients greater than 5 years of age or a behavioral score in patients less than 5 years of age. The retrospective cohort received postoperative analgesia with intermittent doses of intravenous nalbuphine (Group 2).Measurements And Main ResultsGroup 1 had decreased postoperative analgesic requirements, decreased intraoperative inhalational anesthetic requirements, and a longer time to the first request for postoperative analgesia than Group 2. The time to the first request for postoperative analgesia was 16.0 +/- 9.1 hours in Group 1 and 1.6 +/- 1.2 hours in Group 2 (p < 0.0001). Six of 12 patients in Group 1 required no analgesic drugs during the first 24 postoperative hours while all 12 patients in Group 2 (p = 0.02) did require analgesic drugs during this period. The patients in Group 1 who did not require supplemental analgesic drugs maintained pain scores of 2 or less throughout the first 24 postoperative hours.ConclusionLumbar IT morphine provides effective analgesia following repair of frontal encephaloceles in children and adolescents.

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