A new study published in Pediatrics suggests that morphine can result in life-threatening respiratory problems when given to children after a tonsillectomy. According to Medical News Today, these complications were so worrisome that the study period was ended early by the Drug Safety Monitoring Board.
Conversely, the study ]found ibuprofen to be a safe and effective alternative for post-operative pain in children who had their tonsils removed. Dr. Doron Sommer, one of the authors of the study, said “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,” according to Medical News Today.
Most of the time, tonsillectomy is performed to treat cases of childhood sleep apnea. The American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) says that obstructive sleep problems account for 80 percent of tonsillectomies.
This is not the first time research has linked painkillers to serious respiratory side effects in children. Medical News Today reports that codeine, formerly the standard course of treatment for post-operative pain, was associated with life-threatening respiratory side effects in 2009 and 2012. Because of this, the U.S. Food and Drug Administration (FDA) added its most serious “Boxed Warning” to the drug’s safety label.
For the new Pediatrics study, researchers from Motherisk Program at The Hospital for Sick Children, McMaster University in Ontario, Canada and McMaster Children’s Hospital randomly assigned painkillers to 91 children between the ages of 1 and 10 post-tonsillectomy. One group of children were prescribed standard doses of oral morphine (0.2-0.5 mg/kg) and acetaminophen (10-15 mg/kg) to take every four hours while the other group was prescribed standard doses of oral ibuprofen (10 mg/kg) and acetaminophen (10-15 mg/kg) every 6 hours and every 4 hours, respectively. Parents were told to use a home pulse oximeter to measure their children’s oxygen saturation and any pauses in breathing. Additionally, they recorded pain levels on the first and fifth days using the Objective Pain Scale and Faces Scale.
Post-operative pain was effectively managed in both groups, but there were significant differences in respiratory measures. Oxygen desaturation events improved in 68 percent of children who received ibuprofen on the first night after the surgery. This compares to only 14 percent in the group that received morphine. Furthermore, the morphine group exhibited more desaturation events over time, with the rate reaching 11-15 events per hour.
The respiratory issues were of such concern that the study was ended midway through the intended period, Medical News Today reports. In particular, one child suffered a near fatal drug reaction to morphine which included oxygen desaturation. “The evidence here clearly suggests children with obstructive sleep apnea should not be given morphine for post-operative pain. We already know that they should not get codeine either,” said Dr. Gideon Koren, a study author. “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,”