Study Suggests Post-Op Morphine Can Be Fatal for Children

Treating children with morphine following the removal of tonsils can be life threatening and cause respiratory problems according to a new Canadian study.

The study, co-conducted by the Motherisk Program at Toronto’s Hospital for Sick Children and McMaster University Medical Centre has identified potential risks. According to the research, there is significant risk for potentially fatal breathing disruption when morphine is administered at home after surgery to treat pain in children.

The common surgery is routinely done to treat childhood sleep apnea and the study shows that ibuprofen is a safe and effective alternative. The information was published on January 26^th, 2015 in the online edition of the Journal of Pediatrics. The research follows a 2009 Motherisk study and a 2012 study that looked at codeine administered for post-operative pain and respiratory problems including fatal outcomes. Previously, codeine had been the standard treatment for post-operative pain across North America.

As a result of that research, both Health Canada and the U.S. Food and Drug Administration issued warnings about the associated risks. In the new study, 91 children between the ages of one and 10 were randomly assigned to receive post-operative painkillers at home following their tonsillectomy surgery to treat sleep apnea.

“Parents were given a prescription to fill and were instructed about the use of a home pulse oximeter to measure oxygen saturation and apnea events (pauses in breathing) the night before and the night after surgery,” reads the study. “Parents were also taught to use the Objective Pain Scale and Faces Scale to assess their children's pain levels on post-operative days one and five.”

The study was conducted from September 2012 to January 2014 with pain effectively managed and comparable in both groups of children. On the first post-operative night, 68 per cent of children in the ibuprofen group showed improvement in oxygen desaturation incidents (a drop in oxygen concentration in the blood). On the same night, only 14 per cent of children in the morphine group improved. In fact, in the short term, the condition of these children worsened, with substantially more desaturation events in the morphine group - roughly 11 to 15 events per hour. Both groups had similar minimal levels of other adverse drug reactions and bleeding.

"The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for post-operative pain. We already know that they should not get codeine either," said Dr. Gideon Koren, corresponding author of the study, Director of the Motherisk Program and Senior Scientist at SickKids. "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."

The study concludes that clinicians should re-think the routine use of morphine for post-operative pain in children with sleep apnea. Tonsillectomy is among the most common paediatric surgical procedures and in Ontario an estimated 14,000 surgeries are performed yearly.