Oral Morphine Dosing Predictions Based on Single Dose in Healthy Children Undergoing Surgery

Authors

Joy M Dawes, Great Ormond Street Hospital
Erin M Cooke, University of British Columbia
Jacqueline A Hannam, University of Auckland
Katherine A Brand, Evelina London Children's Hospital
Pamela Winton, Royal Hospital for Sick Children
Ricardo Jimenez-Mendez, University of British Columbia
Katarina Aleksa, Hospital for Sick Children
Gillian R Lauder, University of British Columbia
Bruce C Carleton, University of British Columbia
Gideon Koren, Hospital for Sick Children
Michael J Rieder, Western University
Brian J Anderson, University of Auckland
Carolyne J Montgomery, University of British Columbia

Document Type

Article

Publication Date

1-2017

Journal

Paediatric Anaesthesia

Volume

27

Issue

1

First Page

28

Last Page

36

URL with Digital Object Identifier

https://doi.org/10.1111/pan.13020

Abstract

BACKGROUND: Oral morphine has been proposed as an effective and safe alternative to codeine for after-discharge pain in children following surgery but there are few data guiding an optimum safe oral dose.

AIMS: The aim of this study was to characterize the absorption pharmacokinetics of enteral morphine in order to simulate time-concentration profiles in children given common oral morphine dose regimens.

METHODS: Children (2-6 years, n = 34) undergoing elective surgery and requiring opioid analgesia were randomized to receive preoperative oral morphine (100 mcg·kg

RESULTS: The oral morphine formulation had F 0.298 (CV 36.5%), T

CONCLUSIONS: Oral morphine 200 mcg·kg then 100 mcg·kg-1 4 h or 150 mcg·kg-1 6 h achieves mean concentrations associated with analgesia. There was high serum concentration variability suggesting that respiration may be compromised in some children given these doses.