Page 114 WHO - Guidelines on the pharmacological treatment of persisting pain in children with medical illness

GRADE Table 6

Author: Wiffen PJ A1
Date: 17-04-2009
Question: Should morphine vs. buprenorphine be used for post-operative pain after orthopaedic
surgery in children aged 6 months to 14 years?
Settings: Children’s hospital, Helsinki, Finland.
Bibliography: 1. Maunuksela E-l et al. Double-blind multiple-dose comparison of buprenorphine
and morphine in postoperative pain of children. British Journal of Anaesthesia, 1988, 60:48–55; 2.
Maunuksela E-l et al. Comparison of buprenorphine with morphine in the treatment of postoperative
pain in children. Anesthesia Analgesia, 1988, 67:233–239. A2

Summary of findings
Quality assessment
No. of patients Effect

No. of studies Design Limitations Inconsistency Indirectness Imprecision Other considerations IV morphine IV buprenorphine Relative (95% CI) Absolute Quality A3

Pain intensity (follow-up: 1–3 days ; 10-point CATPI by nurses; verbal rating by patient)
a
2 Rand- No No serious Serious No None Study 1 Study Descrip- – LOW
omized serious inconsist- -2 b serious (28) 1 (29) tive data, A4 A4
trials limita- ency impreci- Study Study both
tions sion 2A (32) 2A (28) classed as
good or
very good c
Adverse events (follow-up: 1–3 days ; not clear apart from categorical scale for sedation)
a
2 Rand- No No serious Serious No None Descrip- – No evalu- – LOW
omized serious inconsist- -2 b serious tive data able data
trials limita- ency impreci- only d A5
tions sion
IV, intravenous; CI, confidence interval; CATPI, categorical pain intensity.
a Study 1: 24 hours; Study 2: to the morning of the 3rd post-operative day.
b Acute post-operative pain study.
c Morphine and buprenorphine as analgesics assessed as good or very good in both studies.
d Study 1 (morphine 100 or 50 mcg/kg or buprenorphine 3 or 1.5 mcg/kg) both drugs produced marked sedation – A6
no difference between the groups. Study 2A (morphine 100 mcg/kg or buprenorphine 3 mcg/kg).
Study 2A and 2B: 13 reports of adverse events in 28 participants on buprenorphine, 19 reports of AEs in
32 participants on morphine. Vomiting: eight reports in participants on buprenorphine, five reports in participants
on morphine. Urinary retention: six reports in each group.

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