title: Epidural morphine with butorphanol in pediatric patients.
abstract: OBJECTIVE
  To determine whether the addition of butorphanol to epidural morphine is effective in reducing the frequency of side effects caused by neuraxial opioids.
  
  
  METHODS
  Randomized, double-blind study.
  
  
  METHODS
  Large tertiary care pediatric hospital.
  
  
  METHODS
  20 children between the ages of 2 and 17 years undergoing spinal, abdominal, or thoracic procedures.
  
  
  METHODS
  Patients were divided randomly into one of two groups to receive either 80 micrograms/kg of preservative-free epidural morphine (Group 1) or 80 micrograms/kg of preservative-free epidural morphine with 40 micrograms/kg of butorphanol (Group 2).
  
  
  RESULTS
  Blood pressure, heart rate, respiratory rate, and the first need for additional opioids were monitored in the two groups. In addition, pruritus, nausea and vomiting, and supplemental oxygen (O2) required to maintain oxygen saturation (SpO2) above 90% were monitored. Children who received butorphanol in addition to epidural morphine were much less likely to develop pruritus or nausea and vomiting or to require supplemental O2 to maintain SpO2 above 90%.
  
  
  CONCLUSIONS
  Butorphanol 40 micrograms/kg added to epidural morphine 80 micrograms/kg is effective in decreasing the occurrence of side effects caused by neuraxial opioids in pediatric patients.
authors.affiliation: Division of Pediatric Anesthesia, Arkansas Children's Hospital, Little Rock 72202-3591.
authors.forename: C D
authors.initials: CD
authors.lastname: Lawhorn
authors.forename: R E
authors.initials: RE
authors.lastname: Brown
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural; D001794:Blood Pressure / Q000187:drug effects; D002077:Butorphanol / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004338:Drug Combinations; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects; D009325:Nausea / Q000139:chemically induced; D010100:Oxygen / Q000097:blood; D010102:Oxygen Inhalation Therapy; D010149:Postoperative Pain / Q000517:prevention & control; D010865:Pilot Projects; D011446:Prospective Studies; D011537:Pruritus / Q000139:chemically induced; D012119:Respiration / Q000187:drug effects; D014839:Vomiting / Q000139:chemically induced
chemical_list: D004338:Drug Combinations; D009020:Morphine; D002077:Butorphanol; D010100:Oxygen