Effectiveness of Local Wound Infiltration with Morphine, Ketorolac, and Bupivacaine Compared to Bupivacaine Alone Following Tibial Osteotomy in Pediatric Patients: A Randomized Controlled Trial

Piyanuch  Musikachart; Thanase  Ariyawatkul; Jidapa  Wongcharoenwatana; Nath Adulkasem; Perajit Eamsobhana

doi:10.33192/smj.v77i5.271038

Authors

Piyanuch Musikachart Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Thanase Ariyawatkul Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Jidapa Wongcharoenwatana Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Nath Adulkasem Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
Perajit Eamsobhana Department of Orthopedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.33192/smj.v77i5.271038

Keywords:

Tibial osteotomy, postoperative pain, wound infiltration, morphine, ketorolac, bupivacaine

Abstract

Objective: To compare postoperative pain in children receiving ketorolac plus morphine local wound infiltration as adjunct analgesic agents with bupivacaine for local wound infiltration following tibial osteotomy.

Materials and Methods: This randomized, double-blind, placebo-controlled trial included patients aged 7-15 years who underwent tibial osteotomy. Participants were allocated into two groups. The combination group received wound infiltration with 0.5 ml/kg bupivacaine 0.25%, 0.5 mg/kg ketorolac, and 0.05 mg/kg morphine, while the control group received bupivacaine alone before skin closure. Primary outcomes were Visual Analog Scale (VAS) pain scores measured every 4 hours during the first 48 hours after surgery. Secondary outcomes included morphine consumption and opioid-related complications.

Results: Among the 48 patients included in the study, no significant differences were observed in postoperative VAS pain scores between the two groups at nearly all time points. The combination group showed a trend towards higher mean pain levels compared to the control group at almost every time point from 4 hours to 48 hours post-operation. The maximum mean postoperative pain level in both groups, at four hours, was higher in the combination group, with a maximum mean postoperative pain level of 2.1 vs. 1.9. Higher mean opioid use was noted in the combination group, with a mean of 0.04±0.08 mg/kg vs. 0.03±0.04 at 4-8 hours postoperatively. The cumulative morphine dose was lower in the control group compared to the combination group.

Conclusion: The addition of ketorolac and morphine to bupivacaine for wound infiltration did not reduce postoperative VAS pain scores or opioid consumption following tibial osteotomy in children.

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