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Morphine Linked With Adverse Outcomes Post-Tonsillectomy

Research suggests children with obstructive sleep apnea should not be given morphine for post-op pain

MONDAY, Jan. 26, 2015 (HealthDay News) -- Use of morphine post-tonsillectomy should be limited, as it may be unsafe in certain children, according to a new study published online Jan. 26 in Pediatrics.

The Canadian study included 91 children, aged 1 to 10 years. The patients received different types of pain treatment at home after outpatient surgery to remove their tonsils and/or adenoids in order to treat sleep apnea. One group of patients received standard postoperative doses of oral morphine and acetaminophen based on the child's weight every four hours. The other group took standard doses based on a child's weight of oral ibuprofen every six hours and acetaminophen every four hours.

Pain control was similar in both groups, the study authors found. But, on the first night after surgery, 68 percent of children in the ibuprofen group showed improvement in oxygen levels compared with 14 percent of those in the morphine group. The children in the morphine group had about up to 15 more incidents per hour of oxygen desaturation events than children in the ibuprofen group. The risk to children in the morphine group was deemed so serious that the study was halted early.

"The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for postoperative pain. We already know that they should not get codeine either," Gideon Koren, M.D., one of the study's authors and a senior scientist at the Hospital for Sick Children in Toronto, said in a McMaster University news release. "The good news is that we now have evidence that indicates ibuprofen is safe for these kids, and is just as effective in controlling their pain, so there's a good alternative available for clinicians to prescribe."

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