The comparison of three different caudal morphin dosages i̇n postoperative pain control after salter osteotomy i̇n children wi̇th congenital hip dislocation

Postoperative pain is an important problem effecting morbidity in surgical cases. Single dose caudal block is a safe and easily applicable method in children. Caudal morphin has an important advantage of long effect durations. However in caudal morphin application some side effects such as nausea, vomitting, ürinary retention, pruritis, sedation and respiratory depression can be seen and many of those are dose-dependent. The aim of this study was to determine the minimum morphin dosage that preserves efficient analgesia and by this way to minimize the life threatening side effects like respiratory depression and side effects disturbing patients' comfort such as nausea and vomiting. This double-blinded, randomised study included 60 children, aged between 1-9 years, with the ASA score of I-II who were planned to be operated for congenital hip dislocation. Premedication was not performed in any of the cases. Patients were randomly assigned to 3 equal groups in order to be given 15, 20 or 25 µg.kg caudal morphin (G15, G20 ve G25). Caudal injections were performed under general anesthesia before the operation. The solution with a total volume of 0,75 ml.kg containing 0.25% bupivakain and 15, 20 or 25 µg.kg morphin according to the groups was injected caudally. The first analgesic requirement times were recorded. The number of cases required analgesics in the first 24 hours were determined as 4(20%) in group 15, 3(15%) in group 20, and 2(10%) in group 25. There was not a statistically significant difference between groups in regards to the number of patients required analgesia. Nausea-vomitting was reported in 1(5%) case in group 15, in 2 (10%) cases in group 20, and in 8 (40%) cases in group 25 and the difference between G15 and G25 was statistically significant (p=0.028). Respiratory depression was not observed in any of the cases. In conclusion we determined that decreasing the caudal morphin dose up to 15 µg.kg-1 in salter osteotomies does not decrease analgesic requirements in first 24 hours but it diminishes nausea and vomitting.