Postoperative pain in children with cancer can be safely managed with simultaneous epidural and intravenous opioids, according to researchers at St. Jude Children's Research Hospital in Memphis, Tennessee.
In the April Journal of Pain and Symptom Management, Dr. Doralina L. Anghelescu and colleagues review their center's experience with this practice. Because antipyretic agents can mask fever in neutropenic patients and NSAIDs can exert antiplatelet effects and interact with chemotherapeutic agents, epidural analgesia is frequently supplemented with intravenous opioids, the authors explain.
Among 117 consecutive cases in which pain was managed by continuous epidural opioid infusion and concomitant intravenous opioid infusion, there was only one clinically significant respiratory adverse event (a rate of 0.85%), which occurred in a 10-month-old infant after inadvertent administration of 5 mg of morphine rather than the 0.5 mg morphine that had been prescribed.
There were no neurological complications and only 2 minor respiratory complications, the investigators say.
"The respiratory depression rate…in our investigation of dual-route opioids is comparable to that reported for single-route epidural opioid administration or patient-controlled analgesia in adults and children," the researchers note. "It is also comparable to our institutional complication rate of 0.56% with patient-controlled analgesia opioids alone."
"Our data suggest that in an appropriate environment, it is safe to use intravenous opioids, given either PRN or via patient-controlled analgesia, to supplement postoperative opioid-containing epidural anesthesia in pediatric oncology patients," the authors conclude.
J Pain Symptom Manage 2008;35:412-419.
Reviewed by Dr. Ramaz Mitaishvili
