Pediatric anesthesia & critical care
A Randomized Controlled Trial of Intrathecal versus Caudal Morphine-Bupivacaine on Postoperative Analgesia and Cortisol Levels in Pediatric Patients
Authors' conclusion
Intrathecal morphine and bupivacaine results in longer duration of analgesia, lower analgesic consumption, prevents surgical-stress-related elevation of serum cortisol, and improves parent satisfaction compared to caudal morphine with bupivacaine in children undergoing lower abdominal surgeries.
Study context
- Population
- Children undergoing lower abdominal surgeries
- Participants
- 40 children
- Comparison
- Intrathecal vs caudal morphine-bupivacaine
- Intrathecaln = 20
- Caudaln = 20reference
- Primary endpoint
- Time to reach FLACC score ≥4 postoperatively
Primary result
As reported in the abstract
Time to FLACC score ≥4 (occurrence of pain)
Each group vs caudalEstimate (95% CI)P value
Intrathecal
HR (unadjusted) 0.07(0.03–0.15)
P < 0.001Intrathecal
HR (adjusted for gender) 0.06(0.03–0.14)
P < 0.001- Probability of Face, Legs, Activity, Cry, and Consolability (FLACC) score <4 significantly higher with intrathecal than caudal morphine-bupivacaine (Kaplan-Meier)
- P < 0.001
- Seventy-five percent ('seventy 5%') of intrathecal patients did not reach FLACC score ≥4 within 24 hours
- seventy 5%
Secondary outcomes
| Outcome | Difference in means (μg/dL) (95% CI) | P value | |
|---|---|---|---|
| Serum cortisolAfter intubation | −0.667 (−4.99 to 3.65) | P = 0.76 | |
| Serum cortisol2 hours intraoperatively | 7.88 (3.55–12.2) | P < 0.001 | |
| Serum cortisol6 hours postoperatively | 16.8 (12.5–21.1) | P < 0.001 | |
| Serum cortisol24 hours postoperatively | 15.4 (11.1–19.7) | P < 0.001 | |
| −100102030Difference, μg/dL (linear scale) |
| Outcome | Intrathecal | Caudal | Absolute risk-reduction (95% CI) | P value | |
|---|---|---|---|---|---|
| Intraoperative rescue fentanyl | 20% | 60% | 40% (12%–68%) | P = 0.010 | |
| Postoperative IV paracetamol requirement | 30% | 100% | 70% (50%–90%) | P < 0.001 | |
| −50050100Difference (linear scale) |
Postoperative rescue fentanyl
Median
| Outcome | Intrathecal | Caudal | P value |
|---|---|---|---|
| Parent satisfaction score · 12 hours postoperatively | 2 (IQR 2–2) | 0 (IQR 0–0) | P < 0.001 |
| Parent satisfaction score · 24 hours postoperatively | 2 (IQR 1.5–2) | 0 (IQR 0–1) | P < 0.001 |
Safety
Events
| Outcome | Intrathecal | Caudal |
|---|---|---|
| Nausea and vomiting | 1 | 1 |
| Pruritus | 1 | — not stated in the abstract |
— not stated in the abstract
Respiratory depression
- No incidence of respiratory depression
Original publication
A Randomized Controlled Trial of Intrathecal versus Caudal Morphine-Bupivacaine on Postoperative Analgesia and Cortisol Levels in Pediatric Patients. Anesth Analg. Published 1 May 2025. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →