Effect of intra-op morphine on children with OSA undergoing tonsillectomy

Abstract

Objectives: 1. To compare outcomes after tonsillectomy for pediatric patients with obstructive sleep apnea (OSA) given morphine intra-operatively and post operatively compared to those who were not – specifically Recovery Room (RR) time, length of stay (LOS), Emergency Department (ER) visits. Study design: Retrospective case series with chart review. Setting: Tertiary care children's hospital. Subjects and methods: All children between 1 and 17 years old who had undergone tonsillectomy in a single institution from 2013 to 2016. Comparison between children who had received morphine intra-operatively was made for outcomes. Results: 556 patients were included, 73 patients had morphine intraoperatively and 483 did not; these latter children were older (8.8 vs 6.5 years, P < 0.001), and had fewer episodes of obstructive apnea and hypopnea (AHI 4.47 vs 10.15, p = 0.003) than children who did not receive intra-op morphine. There were no differences in co-morbidities including asthma, whether they had a sleep study, time in the operating room, emergence time, RR time, airway complications, IMC/PICU admission for respiratory distress, ER visits, readmissions, bleeding or post-discharge nurse phone calls. There was a longer LOS (25.9 vs 21.4 h, P = 0.011) for the group receiving intra-op morphine. Conclusion: Children with OSA who receive intra-op morphine have a longer LOS suggesting that its use should be examined more closely in this population.