McMaster University

McMaster University

Faculty of
Health Sciences

Morphine following common childhood surgery may be life threatening

Published: January 26, 2015
Child sleeping
Child sleeping (via Wikimedia Commons)

Treating post-operative pain with morphine can cause life-threatening respiratory problems in some children who have had their tonsils and/or adenoids removed, new research has found.

The study, conducted by the McMaster University and McMaster Children's Hospital with The Hospital for Sick Children (SickKids), has identified a significant risk for potentially-fatal breathing disruption when morphine is administered at home after surgery to treat pain in children who undergo tonsillectomy.

The study, published in today's online edition of Pediatrics, also showed ibuprofen is a safe and effective alternative.

The research builds on previous studies by the two groups that found codeine administered for post-operative pain in the same population of children could cause respiratory problems and fatal outcomes for children who are genetically ultra-rapid metabolizers of codeine. Previously, codeine had been the standard treatment for post-operative pain in this population across North America.

Doron Sommer
Dr. Doron Sommer, clinical professor of surgery at McMaster's Michael G. DeGroote School of Medicine and a surgeon for McMaster Children's Hospital

As a result of the earlier research, both Health Canada and the U.S. Food and Drug Administration (FDA) issued warnings about the risks associated with giving codeine to this population of children. While no official recommendation of a safe and effective alternative had been made in response to these warnings, many centres prescribed morphine to these children believing that the response to the drug would be more predictable.

Clinicians should now re-think the routine use of morphine for post-operative pain in children with sleep apnea, says study co-author Dr. Doron Sommer, clinical professor of surgery at McMaster's Michael G. DeGroote School of Medicine and a surgeon for McMaster Children's Hospital.

"These results should prompt clinicians to re-evaluate their post-tonsillectomy pain treatment regimen.  Due to the unpredictable respiratory side-effects of morphine, its use as a first-line treatment with current dosage ranges should be discontinued for outpatient tonsillectomy," he said.

At both SickKids and McMaster Children's Hospital, the use of morphine for post-operative pain from pediatric tonsillectomy is reserved for exceptional cases where it is deemed necessary and safe with appropriate monitoring.

Tonsillectomy is among the most common pediatric surgical procedures, used to treat childhood sleep apnea. In Ontario, about 14,000 tonsillectomies are performed each year.

The research is supported by the Drug Safety and Effectiveness Network of the Canadian Institutes of Health Research, and the SickKids Foundation.

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