NHS

[Random Orbital Bob]

Yup. I was fighting them off my son last night. I wound up proclaiming sleep was the best medicine. Not sure they appreciated that

 

[Lons]

Dare I ask what happened to him Bob?

 

[Random Orbital Bob]

He has an extremely rare congenital bone defect in his shin. Tends to break and tends then not to heal. Had a rod in it since 18 months old. Somehow it got infected, we know not how but the infection is in his leg bone and we need to get rid of it. Bottom line, surgery to remove rod, ream the bone to remove most of bugs then extreme IV antibiotics to try and chase down all the remaining bugs. Not pleasant and the little soldier is so tough but when he said "Daddy the pain is so bad I just want to die" at 8 years old, it dam near broke my heart.

The good news is today after about noon he's really picked up as the pain volume has subsided some. Now the pain meds can keep on top of it instead of that nerve jangling post op pain that even morphine wasn't getting close to. This is his third general anaesthetic at only 8 years old. He's such a warm hearted and loving lad, life has some cruel twists at times and he has had a lifetimes worth of excruciating pain.

 

[Harbo]

My heart goes out to him - wish him well?

Rod

 

[Baldhead]

He has an extremely rare congenital bone defect in his shin. Tends to break and tends then not to heal. Had a rod in it since 18 months old. Somehow it got infected, we know not how but the infection is in his leg bone and we need to get rid of it. Bottom line, surgery to remove rod, ream the bone to remove most of bugs then extreme IV antibiotics to try and chase down all the remaining bugs. Not pleasant and the little soldier is so tough but when he said "Daddy the pain is so bad I just want to die" at 8 years old, it dam near broke my heart.

The good news is today after about noon he's really picked up as the pain volume has subsided some. Now the pain meds can keep on top of it instead of that nerve jangling post op pain that even morphine wasn't getting close to. This is his third general anaesthetic at only 8 years old. He's such a warm hearted and loving lad, life has some cruel twists at times and he has had a lifetimes worth of excruciating pain.

Bob your sons the same age as my granddaughter, if she said that to me it would break my heart, let's hope this is the end of all his problems.

Baldhead

 

[Racers]

Good to hear he's on the mend, I hope it doesn't happen again.

Make sure you spoil him when you get him home.

Pete

 

[Kalimna]

Bob - my heart goes out you and your son. I happen to work in the operating theatres, and whenever I have a child of a similar age to my own (4 and 2) to anaesthetise it is quite an emotional drain, particularly if an emergency.
Fingers crossed that pain control continues, he makes a speedy recovery and it is a long time indeed before he needs the care of the orthopaedic department again.

Cheers,
Adam

(Incidentally, the word "ortho-paedic" means to "straighten children" and, as a specialty, was originally concerned with attempts at 'curing' deformed backs)

 

[Random Orbital Bob]

Many thanks again to all of you. I'm with him now and we had another relapse this morning which necessitated iv morphine. He's stable again now but I've recently learned that Codeine has been withdrawn for kids under 12 due to clinical trials investigating negative side effects. This leaves paracetamol and ibuprofen to manage severe post operative pain and frankly it's simply not sufficient. Surely intra venous morphine is more risky to an under 12 than codeine?

 

[KevM]

Bob,
Apparently codeine is metabolised to morphine at vastly different rates within different children, and thus its effects are pretty much unpredictable; I hope you can get some resolution to the immediate pain management issues for your lad and that he responds well to treatment.
I've followed this thread since you first posted but hesitated to say anything for fear of being glib or trite, a stranger's words have little meaning at a time like this, but you are very much in my thoughts.

Kev

Edited to add a source:
The Royal College of Paediatrics and Child Health guidance note:

Updated guidance for use of codeine in children
Following a review of the literature and analysis of several deaths outside hospital, the advice given by the Medicines and Healthcare products Regulatory Agency (MHRA) on the use of codeine in children has changed (June 2013).

The MHRA now advise that codeine should not be used in any child with a history of sleep apnoea who is undergoing tonsillectomy or adenoidectomy and that codeine should only be used in children over the age of 12 years.

The basis of this directive is the understanding that codeine is variably metabolised to morphine and that some children (fast metabolisers) will be vulnerable to unpredictable and excessive respiratory depression particularly those who have pre-existing alteration in ventilatory drive (e.g. chronically obstructed airways from enlarged tonsils).

Codeine has been used for many years as supplementary analgesia for children outside the hospital setting. Following the MHRA directive, hospitals and pharmacies have had to reconsider how best to find safe alternative solutions to analgesia that cannot be adequately controlled with paracetamol and non-steroidal anti-inflammatory drugs following discharge home. Within the United Kingdom, different solutions are being employed. This includes continuing to use codeine with increased caution or the adoption of alternative opioid medication regimens.

The RCPCH, Neonatal Paediatric Pharmacists Group, Royal College of Anaesthetists and Association of Paediatric Anaesthetists of Great Britain and Ireland have produced a statement on the use of codeine in children. This includes guidance on the selection and use of alternative opiods, including oral morphine, dihydrocodeine, and tramadol. However, it should be emphasised that none of these provide the ideal solution to this difficult analgesic problem and that for some children the length of stay in hospital may need to be extended to allow opioid analgesia to be provided safely.

Full guidance document