Study highlights safety concerns over morphine use after tonsillectomy

A randomised trial involving 91 children undergoing tonsillectomy has highlighted safety concerns with morphine for pain management after surgery

In children who have undergone tonsillectomy, it has not been clear which analgesic is best to use. Codeine has recently been contraindicated for pain management after surgery; remaining options include morphine and ibuprofen.

Now, results of a randomised trial[1]
involving 91 children undergoing tonsillectomy for breathing problems at night have highlighted safety concerns with morphine. On the first night after surgery, just 14% of children given morphine showed an improvement in blood oxygen levels, compared with 32% of those given ibuprofen. Furthermore, apnea events were significantly more frequent with morphine than ibuprofen — a difference of 11 events per hour, on average.

“The evidence clearly suggests that children with obstructive sleep apnoea should not be given morphine for post-operative pain,” says lead study author Gideon Koren of the Hospital for Sick Children in Toronto, Canada.


[1] Kelly LE, Sommer DD, Ramakrishna J et al. Morphine or ibuprofen for post-tonsillectomy analgesia: A randomized trial. Pediatrics 2015; 135(2):307–313; doi:10.1542/peds.2014-1906.

Last updated
The Pharmaceutical Journal, PJ, 7 February 2015, Vol 294, No 7848;294(7848):DOI:10.1211/PJ.2015.20067756