Introduction and Objectives: Orthopaedic surgery is associated with significant pain in the immediate postoperative period. Management of this pain often requires the administration of opiates. The goal of this study is to evaluate the efficacy of analgaesic treatment with intravenous morphine hydrochloride in a nurse-controlled analgaesia (NCA) system during the first day postoperative in children in general hospital wards.

Materials and Methods: The study included 69 consecutive patients, all under 6 years of age, who underwent scheduled orthopedic surgery. All patients were treated postoperatively using intravenous morphine hydrochloride using the NCA system according to the following protocol: loading dose: 50–100 μg/kg; continuous infusion: 10–20 μg/kg/h; bolus dosage: 4- μg/kg: closure time: 20”; maximum dose: 400 μg/kg/4h. The following variables were evaluated: 1). Intensity of pain: none = 0 / mild = 1 / moderate = 2 / very intense = 3; 2). Side effects: a) nausea and vomiting: none =0 / 1 episode in 4 hours = 1 / more than 1 episode in 4 hours = 2. b) Urinary retention: none = 0 / spontaneous micturition after less than 8 h = 1/ draining catheter required = 2; 3). Average morphine chloride dose/kg of weight.

Results: Average age was 24.3 months (range: 4 months – 6 years). Average weight: 12.7 kg. Results showed no case of excessive sedation or respiratory depression. Average morphine hydrochloride dosage per kg body weight was 365.5 μg (± 402.5 μg).

Discussion and Conclusions: The guidelines of our I.V. morphine hydrochloride protocol for NCA yielded satisfactory control of post-operative pain after trauma surgery in children under 6 years old. No major side effects were noted in our patients, and the protocol may be safely used.

We have analysedin the results of 24 femoral lengthenings in 23 patients operated on between 1993 and 2000, using a gradual elongation intramedullary nail (Albizzia). Of the 23 patients, 22 had femoral deficiency and one was of short stature. Their mean age was 16.9 years. Technical difficulties encountered during the procedure were mild or moderate in 18 femora and severe in six femora. Distraction was obtained by 15 ratchetings per day (1 mm/day).

There were 18 excellent results although in two patients this was achieved after the development of a pseudarthrosis which required further surgery. There were four good and two fair results in which the lengthening obtained was at least 3 cm less than had been projected. The consolidation index was 35.2 days/cm. No patient had associated long-term stiffness of the knee.

Femoral lengthening using an elongation nail gives good results and is a comfortable procedure.