Purpose: Children with cancer often mention needle procedures as the most frightening, distressing and sometimes painful aspect of the disease and treatment.The aim was to investigate whether children experience less fear, distress, and/or pain according to parents, nurses, and children>7 years of age when they receive oral morphine vs. placebo before a needle is inserted in a subcutaneously implanted intravenous port and if there is a difference in procedure time.
Method: Fifty children 1–18 years of age who were being treated in a pediatric oncology and hematology setting were included consecutively when undergoing routine needle insertion into an intravenous port. All children were subjected to one needle insertion and recieved EMLA in this randomized, triple-blind, placebo controlled study in which orally administered morphine (n¼26) 0.25 mg/kg body weight was compared with placebo (n¼24). Parents, nurses and children>7 years reported the patients’ fear, distress, and pain on 0–100 mm Visual Analogue Scales. In addition behavioral observation with CHEOPS for pain and PBCL for procedure related distress was performed.
Results: No differences between the morphine and the placebo group were found with respect to age, weight, height, physical status, sex, weeks from diagnosis, or weeks from latest needle insertion. According to parents, nurses, and children oral morphinein a dose of 0.25 mg/kg body weight did not reduce the primary outcome measure fear; neither did it reduce distress nor pain in the morphine group compared to placebo. No differences in behavioral observations with CHEOPS and PBCL or procedure time for morphine vs. placebo were found.
Conclusion: Surprisingly, oral morphine in this dose does not add any value in reducing fear, distress or pain combined with topical anaesthesia in pediatric oncology patients undergoing subcutaneous port needle insertion, and it probably would not add any value for other similar procedures, e.g. venous cannulation.
2010. Vol. 55, no 5, 954-955 p.