Julie Hughes and colleagues report on a pilot study measuring morphine requirements and enteral intake

Aims To determine the effect of nasogastric (NG) feeding compared with oral feeding on morphine requirements after primary cleft palate repair, and secondarily on enteral intake.

Methods This was a pilot study involving 50 infants, aged five to ten months, who were randomised to receive NG or oral feeding after palate repair. All infants received the same anaesthetic and analgesic management. Post-operatively, paracetamol and ibuprofen were administered regularly and intravenous (IV) morphine was given on demand using a nurse-controlled analgesia device. The primary outcome measure was the total morphine consumption in the first 24 hours. Secondary outcome measures included the numbers of painful episodes and the volumes of IV fluid and enteral feed administered.

Results Of the 50 infants enrolled, 18 and 23 received either NG or oral feeding, respectively, and completed the study. Numbers of painful episodes and morphine consumption in the first 24 hours were similar in each group. Volumes of feed administered in the first 24 hours were significantly different: the NG group received approximately three times more than the oral group. Nine of the oral group required IV fluids in the 24 hours compared with none in the NG group.

Conclusion NG feeding was more effective than oral feeding in the first 24 hours after surgery, but numbers of painful episodes recorded were similar. Further research is required.