الفهرس 
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Abstract
Summary
Although the understanding of pain has advanced, managing postoperative pain remains a significant problem worldwide.Among all the management approaches, patient-controlled analgesia is an effective and well-established approach to relieve acute postoperative pain. Morphine is a potent analgesic commonly used in PCA but with adverse effects that may be fatal if not managed properly.
This study was carried out in Beni-Suef University Hospital to evaluate the efficacy and safety of low dose morphine in control acute pain in children undergoing exploration surgery.
Pain severity was assessed using the VAS and VRS scores at rest and movement. Assessment was done at 1, 2, 6, 12, 24, 36 and 48 hours. At all times there was no significant difference between the studied groups regarding the mean VAS and VRS scores of pain and their categories.
The mean age of patients received the standard dose of morphine was 8.8±0.8 years and most of them were male (69.6%). Also, patients received low dose morphine had an average age 9.1±0.8 years and most of them were males (56.5%). Their average weight was 28.1±3.4 kg for patients with standard dose and 29.2±3.8 kg for patients with low dose morphine. All patients in both groups were ASA physical status I and the mean duration of surgery was 1.9±0.3 hours in patients with standard dose and 2±0.4 in patients with low dose morphine.
The mean heart rate and mean arterial blood pressure were within normal. There was no significant difference between the studied groups regarding the heart rate and mean arterial blood pressure at 1,2, 6, 12, 24, 36 and 48 hours post operatively. In both groups, the heart rate decreased significantly from 1 to 2, 2 to 6, 6 to 12, 12 to 24, 24 to 36, and from 36 to 48 hours.
Post-operative assessment of sedation showed that the mean POSS score was 1.3±0.4 for patients with standard dose of morphine and 1.1±0.3for patients with low dose of morphine. There was no significant difference between the studied groups regarding the mean POSS scores.
Regarding the post-operative side effects of morphine, our study showed that the highest rate of PONV was within 12 hours post-operative seen in 9 patients (39.1%) in standard dose group and at the same time only 3 (13%) of patients at the low dose group complained of PONV. There was a significant difference between the studied groups regarding the occurrence of PONV at 6,12,24, and 36 hours. Throughout all postoperative follow up period higher rates were observed in the standard dose group. As regards to the respiratory depression, 7 patients (30.4%) received the standard dose showed respiratory depression and only 1 patient (4.3%) had respiratory depression in the low dose group. There was a significant difference between the studied groups regarding the occurrence of respiratory distress.