Administering morphine to children to manage post-op pain may cause serious life-threatening respiratory risks, a new study suggests.

The study found that children with sleep apnea who were prescribed morphine to treat post-op pain following a tonsillectomy had higher incidences of oxygen desaturation than those given ibuprofen.

Previously, researchers say many providers administered codeine for children to manage post-op pain, but studies over the last few years have shown it could result in breathing problems and fatal outcomes for children with sleep apnea. Following these studies, Health Canada and the FDA issued warnings about the use of codeine for children, and morphine became the standard treatment.

The new study, conducted by The Hospital for Sick Children, McMaster University and McMaster Children's Hospital in Canada, looked at the use of morphine in children undergoing a tonsillectomy to treat sleep apnea and found that it also poses dangerous respiratory risks. The study's authors say ibuprofen may be a better alternative.

The study, published in Pediatrics, looked at 91 patients with sleep apnea between 12 months and 10 years old who were undergoing tonsillectomies with or without adenoidectomies. One group of children was given post-op standard doses of oral morphine and acetaminophen every 4 hours to treat pain, while the other group was given standard doses of ibuprofen every 6 hours and acetaminophen every 4 hours. Parents were instructed to monitor their children's pain, oxygen saturation and apnea events both the night before and the night after surgery.

Researchers found that those who received morphine had significantly more post-op incidents of oxygen desaturation and faced a higher risk of fatal respiratory problems than those who received ibuprofen. The study found that in both groups, post-op pain and bleeding were comparable.

The study was even halted halfway through its planned time period because one child who had received morphine suffered a life-threatening oxygen desaturation incident, and researchers found strong evidence linking morphine to potentially-fatal respiratory risks in children with sleep apnea.

"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," says study author Gideon Koren, MD, FRCPC, a pediatrician and pharmacologist at The University of Toronto and the Hospital for Sick Children. "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."

Kendal Gapinski