Comparison of Morphine Given by An Intravenous Sliding Scale or by Intramuscular Route for Postoperative Pain Relief in Pediatric Patients : An Interim Analysis

Abstract

Objectives : To assess the efficacy in pain relief, complication, practicality and patient's compliance of morphine given by IV sliding scale (IV) compared to that given intramuscularly (IM) in children after surgery.
Method : One hundred and third-two children were randomly allocated to receive postoperative morphine via IM route (0.1 mg/kg) on a 6-h PRN basis or IV route on a sliding scale basis. Blood pressure, heart rate, respiratory rate, SaO2, nausea/vomiting, pain score using CHEOPS and patient's compliance were recorded. A questionnaire was used to evaluate the satisfaction with and practicality of these techniques among nurses.
Results : This study was terminated early and interim analysis was performed because 47% of the patients in the IM group refused treatment and only 32 patients remained for study (age 1.9-12y, ASA 1). The proportions of patients with moderate to severe pain (IM 73.3%, IV 76.5%), median of maximum CHEOPS score (IM 9, IV 10), average CHEOPS score (IM 6.01, IV 6.03), and morphine consumption (IM 0.157,IV 0.144 mg/kg/24h) of both groups were not statistically different. Neither respiratory depression nor desaturation was detected. Nurses preferred using the sliding scale technique due to better patient's compliance.
Conclusions : The IV sliding scale was superior to IM technique regarding patient's compliance and nurses' preference. The degree of pain relief obtained and complications of treatment were not different.