Epidural Morphine Combined with Epidural or Intravenous Butorphanol for Postoperative Analgesia in Pediatric Patients

Abstract

We performed a prospective, randomized, double-blinded study in 60 postoperative pediatric patients aged 6 wk to 7 yr to compare the efficacy of butorphanol given epidurally or intravenously in preventing the side effects of epidural morphine. Three groups of patients received 60 micrograms/kg epidural morphine; 20 patients also received epidural butorphanol 30 micrograms/kg, and 20 patients also received 30 micrograms/kg intravenous butorphanol. All patients were evaluated for analgesia, sedation, vomiting, urinary retention, pruritus, and respiratory depression for 24 h postoperatively. Although the overall incidence of side effects was not different in the three groups, the epidural butorphanol group had a significant decrease in severity of pruritus. Sedation was seen more frequently in the groups receiving butorphanol, but was most pronounced in the epidural butorphanol group. We conclude that butorphanol has little or no effect on the side effects of epidural morphine.

Butorphanol prevents morphine-induced pruritus without increasing pain and other side effects: a systematic review of randomized controlled trials

“…The effect of a single injection of intravenous butorphanol on the number of patients requesting rescue treatment for pruritus was evaluated in one trial. 24 The data showed that a single injection of intravenous butorphanol was not effective in decreasing the number of patients requesting rescue treatment for pruritus when compared with placebo (45% vs 40%, respectively).…”

“…Ultimately, 16 valid trials were analyzed with data for 795 patients, 452 of whom received butorphanol (Table 1). [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Four of these trials involved children \ 18 years of age. [21][22][23][24] The methodological quality of the included studies Ten of the 16 included trials 13,18,[20][21][22][23][24][25][26][27] provided a sequence generation for randomization.…”

“…[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] Four of these trials involved children \ 18 years of age. [21][22][23][24] The methodological quality of the included studies Ten of the 16 included trials 13,18,[20][21][22][23][24][25][26][27] provided a sequence generation for randomization. Most trials did not show adequate information about the allocation concealment; 11 studies 12,13,18,[20][21][22][23][24][25][26][27] were double-blinded.…”

“…[12][13][14][15][16][17][18][19][22][23][24] On average, 51.4% (132/257) of patients receiving morphine without butorphanol experienced pruritus. Trials were assigned into different subgroups according to the routes of butorphanol administration, but it was impossible to test the dose-response relationship of butorphanol because few trials used the same dose.…”

“…21,[24][25][26][27] Treatment was requested by 27.1% (39 in 144) of the patients in the epidural butorphanol group and by 46.7% (45 in 96) of the patients in the control group. Thus, prophylactic administration of epidural butorphanol significantly decreased the number of patients requesting curative treatment for pruritus (RR 0.57; 95% CI 0.41 to 0.81) (Fig.…”