Taking pain medication after a surgery is highly understandable, but parents and doctors must be careful about giving children morphine post-operatively as the drug is more dangerous than beneficial, according to a study.
Conducted by The Hospital for Sick Children's Motherisk Program, McMaster Children's Hospital and McMaster University, the study identified a dramatic increase in risks for potentially-fatal disruption in breathing in children given morphine at home after undergoing a tonsillectomy. It builds on work done by two previous studies, one by Motherisk in 2009 and the other by McMaster in 2012, which showed that administering codeine for post-operative pain could lead to respiratory problems and even deaths in children who turn out to be genetically predisposed to metabolize the drug quickly.
Codeine was the treatment of choice for post-operative pain across North America but the results of the two studies prompted the U.S. Food and Drug Administration and Health Canada to issue warnings about the using the drug on children. However, no alternative was recommended so many doctors ended up prescribing morphine instead.
Unfortunately, morphine was no better.
Between September 2012 and January 2014, 91 children from age one to 10 participated in the new study. The children were randomly assigned whether they will be receiving oral morphine or oral ibuprofen to manage their pain while recuperating at home after an outpatient tonsillectomy procedure to address sleep apnea. Aside from prescriptions to be filled, parents were also provided instructions on how to use pulse oximeters at home for measuring apnea events and oxygen saturation before and after their child's surgery.
Results between those who received oral morphine and acetaminophen and those administered ibuprofen and acetaminophen showed that pain management was comparable but only 14 percent of the children in those in the morphine group showed less drops in blood oxygen concentration. The ibuprofen drastically outperformed the morphine group, with 68 percent showing improved blood oxygen levels.
Aside from simply identifying morphine as a risky method of managing pain, researchers are pleased to have actually discovered a good alternative for the drug in the form of ibuprofen.
"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," said Dr. Doron Sommer, a surgeon for McMaster Children's Hospital and a co-author for the study.
Tonsillectomy is one of the most common surgical procedures children undergo. At the McMaster Children's Hospital and The Hospital for Sick Children, morphine is used only when deemed necessary and only when appropriate monitoring is provided.
