Morphine After Tonsillectomy Tied to Breathing Problems in Study

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Using morphine at home to treat pain in children after tonsil and/or adenoid removal may cause life-threatening respiratory problems, according to a new study.

“The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for postoperative pain. We already know that they should not get codeine either,” Dr. Gideon Koren, one of the study’s authors and a senior scientist at the Hospital for Sick Children in Toronto, said in a McMaster University news release.

“The good news is that we now have evidence that indicates ibuprofen [Motrin, Advil] 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,” he added.

In recent years, many doctors began prescribing morphine to young tonsillectomy patients after Canadian and U.S. health officials warned against codeine use, the researchers said.

The Canadian study included 91 children, aged 1 to 10 years. The patients received different types of pain treatment at home after outpatient surgery to remove their tonsils and/or adenoids in order to treat sleep apnea. Obstructive sleep apnea causes the upper airway to become blocked by soft tissue in the back of the throat during sleep. This causes pauses in breathing and other symptoms, such as gasping and snoring.

One group of patients received standard postoperative doses of oral morphine and acetaminophen (Tylenol) based on the child’s weight every four hours. The other group took standard doses based on a child’s weight of oral ibuprofen every six hours and acetaminophen every four hours.

Pain control was similar in both groups, the study authors found. But, on the first night after surgery, 68 percent of children in the ibuprofen group showed improvement in oxygen levels compared with 14 percent of those in the morphine group.

The children in the morphine group had about up to 15 more incidents per hour of dropping oxygen concentration in the blood — called “oxygen desaturation events” — than youngsters in the ibuprofen group, according to the study.

The risk to children in the morphine group was deemed so serious that the study was halted early.

Results of the study were published online Jan. 26 in the journal Pediatrics.

Tonsillectomy is one of the most common surgical procedures among children in the United States. About 80 percent of tonsillectomies are now performed to treat obstructive sleep problems, according to the American Academy of Otolaryngology — Head and Neck Surgery.

More information

The U.S. National Library of Medicine has more about children and tonsillectomies.

Source: HealthDay

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