Ibuprofen Safer Than Morphine for Post-Operative Pain Treatment in Children

Morphine was shown to cause respiratory problems in children with post-operative pain, though ibuprofen was a safe alternative.

Using morphine to treat children for post-operation pain, such as removing tonsils or adenoids, can cause life threatening respiratory problems, but ibuprofen is a safe alternative, according to research published in Pediatrics.

Researchers from various children’s hospitals in Ontario, Canada studied 91 children aged 1 to 10 years between September 2012 and January 2014 in order to determine which post-surgical analgesic agents were safe and efficacious. Children who were scheduled for tonsillectomy with and without adenoid removal were included in the study. Parents of those children were given a pulse oximeter to measure oxygen saturation and apnea events the night prior to and the night after the surgery. The children were randomized into groups to either receive: acetaminophen with either 0.2-0.5 mg/kg oral morphine every 4 hours or 10 mg/kg of oral ibuprofen every 6 hours. The effectiveness of the drugs was assessed using the Objective Pain Scale and Faces Scale on post operative day 1 and day 5.

The research was done to build upon prior studies done in 2009 and 2012, which had indicated codeine administered for post operative pain in children with tonsillectomies and/ or adenoid removals could cause respiratory problems with fatal outcomes, especially in children who are ultra rapid metabolizers of codeine. Codeine was previously the standard treatment for post-operative pain in North America.

The researchers determined pain was effectively managed and comparable in both groups. On the first post-operative night, 68 percent of children in the ibuprofen group demonstrated improvement in oxygen desaturation incidents, while only 14 percent of children in the morphine group improved. Over the short-term follow-up period, the children in the morphine group worsened — there were about 11 to 15 desaturation events per hour. In both groups, there were minimal levels of other adverse drug effects and bleeding.

Halfway into the duration of the study period, an interim analysis was conducted by the study’s Drug Safety and Monitoring Board. One child from the morphine treatment group suffered a life-threatening adverse drug reaction that included oxygen desaturation. The study was halted early due to the event and the Research Ethics Board was notified by both hospitals involved in the study.

“The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for post-operative pain,” Gideon Koren, MD, FRCPC, corresponding author of the study, explained in a press release. “We already know that they should not get codeine either. The good news is that we now have evidence that indicates ibuprofen 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.”

The authors of the study urge clinicians to rethink the use of post-operative morphine, especially in children with sleep apnea. For example, at each hospital involved in the study, morphine treatments for post-operative pain is only reserved for exceptional cases where it is deemed necessary and safe.