Morphine can be used safely in a resource poor tertiary care Hospital for postoperative pain management in children - A retrospective review

Rationale: morphine is not used in our resource poor recovery room because of the stringent rules that hinder its easy availability,fear of respiratory depression and adverse events. this has lead to under treatment of severe pain in the perioperative setting. we used morphine as the opioid of choice in asa i or ii patients undergoing orthopedic surgery to assess the feasibility of using morphine in the perioperative period in our recovery room and identify complications arising from its use. methods: we retrospectively reviewed the charts of patients undergoing orthopedic surgery that had received morphine in the perioperative period from february 2011 to may 2011. sixteen patients met the inclusion criteria. balanced general anesthesia with endotracheal intubation was performed in 14 patients. two underwent general anesthesia with lma. the average morphine dose given was 0.09mg/kg (0.03mg/kg-0.19mg/kg). morphine 0.025mg/kg to 0.1mg/kg was given prior to surgical incision in fourteen patients and as a supplement to caudal analgesia in the recovery room in two patients. further morphine was titrated to keep pain at a visual analog scale (vas) <3 in the recovery room. results: all the patients who received morphine were discharged to the orthopedic ward with vas score of three or less. none of the patients complained of nausea or vomiting or itching. discharge time from recovery room varied from 45 minutes to 150 minutes. there were no adverse events in the recovery room or in the ward. conclusion: safe re- organization of recovery room (rr) allowed us to use morphine without any adverse outcome in a resource poor setting.