{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,16]],"date-time":"2026-04-16T14:46:41Z","timestamp":1776350801481,"version":"3.51.2"},"reference-count":25,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2011,2,10]],"date-time":"2011-02-10T00:00:00Z","timestamp":1297296000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatric Anesthesia"],"published-print":{"date-parts":[[2011,4]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>\n                    <jats:bold>Background:\u2002<\/jats:bold>\n                    High\u2010dose single\u2010shot caudal morphine has been postulated to facilitate early extubation and to lower initial analgesic requirements after staged single\u2010ventricle (SV) palliation.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Methods:\u2002<\/jats:bold>\n                    With Institutional Review Board approval and written informed parental consent, 64 SV children aged 75\u20131667\u2003days were randomized to pre\u2010incisional caudal morphine\u2013bupivacaine (100\u2003\u03bcg\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    morphine (concentration 0.1%), mixed with 0.25% bupivacaine with 1\u2003:\u2003200\u2003000 epinephrine, total 1\u2003ml\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) and postcardiopulmonary bypass (CPB) intravenous (IV) droperidol (75\u2003\u03bcg\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) (\u2018active caudal group\u2019) or pre\u2010incisional caudal saline (1\u2003ml\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) and post\u2010CPB IV morphine (150\u2003\u03bcg\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) with droperidol (75\u2003\u03bcg\u00b7kg\n                    <jats:sup>\u22121<\/jats:sup>\n                    ) (\u2018active IV group\u2019). Assignment remained concealed from families and the care teams throughout the trial. Early extubation failure rates (primary or reintubation within 24\u2003h), time to first postoperative rescue morphine analgesia, and 12\u2010h postoperative morphine requirements were assessed for extubated patients.\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Results:\u2002<\/jats:bold>\n                    Thirty\u2010one (12 stage 2) SV patients received caudal morphine and 32 (15 stage 2) received IV morphine. Extubation failure rates were 6\/31 (19%) for caudal and 5\/32 (16%) for IV morphine. For successfully extubated patients (\n                    <jats:italic>n<\/jats:italic>\n                    \u2003=\u200354), active caudal treatment significantly delayed the need for postoperative rescue morphine in stage 3 patients (\n                    <jats:italic>P<\/jats:italic>\n                    \u2003=\u20030.02) but not in stage 2 patients (\n                    <jats:italic>P<\/jats:italic>\n                    \u2003=\u20030.189) (Kaplan\u2013Meier survival analysis with LogRank test). The reduction in 12\u2010h postoperative morphine requirements with active caudal treatment did not reach significance (\n                    <jats:italic>P<\/jats:italic>\n                    \u2003=\u20030.085) but morphine requirements were significantly higher for stage 2 compared with stage 3 patients (\n                    <jats:italic>P<\/jats:italic>\n                    \u2003&lt;\u20030.001) (two\u2010way\n                    <jats:sc>anova<\/jats:sc>\n                    in\n                    <jats:italic>n<\/jats:italic>\n                    \u2003=\u200350 extubated patients).\n                  <\/jats:p>\n                  <jats:p>\n                    <jats:bold>Conclusions:\u2002<\/jats:bold>\n                    High\u2010dose caudal morphine with bupivacaine delayed the need for rescue morphine analgesia in stage 3 patients. All stage 2 patients required early rescue morphine and had significantly higher postoperative 12\u2010h morphine requirements than stage 3 patients. Early extubation is feasible for the majority of stage 2 and 3 SV patients regardless of analgesic regimen. The study was underpowered to assess differences in extubation failure rates.\n                  <\/jats:p>","DOI":"10.1111\/j.1460-9592.2011.03527.x","type":"journal-article","created":{"date-parts":[[2011,2,10]],"date-time":"2011-02-10T01:38:21Z","timestamp":1297301901000},"page":"441-453","source":"Crossref","is-referenced-by-count":20,"title":["The effect of caudal vs intravenous morphine on early extubation and postoperative analgesic requirements for stage 2 and 3 single\u2010ventricle palliation: a double blind randomized trial"],"prefix":"10.1111","volume":"21","author":[{"given":"Eckehard A. E.","family":"Stuth","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard J.","family":"Berens","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susan. 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