title: Caudal epidural butorphanol plus bupivacaine versus bupivacaine in pediatric outpatient genitourinary procedures.
abstract: OBJECTIVE
  To investigate the efficacy of adding butorphanol to bupivacaine administered in the caudal epidural space in children undergoing genitourinary (GU) procedures.
  
  
  METHODS
  Randomized, double-blinded, controlled study.
  
  
  METHODS
  University affiliated pediatric hospital.
  
  
  METHODS
  200 ASA physical status I and II male patients between 6 months and 10 years of age.
  
  
  METHODS
  Patients were randomized to receive either 0.25% bupivacaine with 1:200,000 epinephrine alone (Group 1) or 0.25% bupivacaine with 1:200,000 epinephrine plus 30 micrograms/kg butorphanol (Group 2) administered via the caudal epidural space prior to surgical incision.
  
  
  RESULTS
  Patients were evaluated postoperatively until discharge. Measurements included requirement of additional analgesic, sedation, pain/ comfort scores, and a 24-hour analgesic follow-up. Significantly fewer patients in the butorphanol group required rescue morphine sulfate in the postanesthesia care unit (p < or = 0.001). The total number of morphine doses administered to Group 2 was significantly less than Group 1 (p < or = 0.001). 52% of patients in Group 1 compared with 28% in Group 2 required administration of additional analgesics following discharge from the hospital (p < or = 0.003), with 23% of Group 1 requiring a codeine compound compared with 8% in Group 2 (p < 0.03).
  
  
  CONCLUSIONS
  The addition of 30 micrograms/kg butorphanol to 0.25% bupivacaine with epinephrine via the caudal epidural space is a safe, effective means to increase duration of analgesia following GU procedures.
authors.affiliation: Division of Pediatric Anesthesia, Arkansas Children's Hospital, Little Rock, USA.
authors.forename: C D
authors.initials: CD
authors.lastname: Lawhorn
authors.forename: J M
authors.initials: JM
authors.lastname: Stoner
authors.forename: M L
authors.initials: ML
authors.lastname: Schmitz
authors.forename: R E
authors.initials: RE
authors.lastname: Brown
authors.forename: F W
authors.initials: FW
authors.lastname: Stewart
authors.forename: P
authors.initials: P
authors.lastname: Volpe
authors.forename: R
authors.initials: R
authors.lastname: Shirey
mesh_terms: D000556:Ambulatory Surgical Procedures; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000767:Anesthesia, Epidural; D000779:Anesthetics, Local / Q000008:administration & dosage; D002045:Bupivacaine / Q000008:administration & dosage; D002077:Butorphanol / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D004837:Epinephrine; D005835:Genitalia / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D010147:Pain Measurement
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002077:Butorphanol; D002045:Bupivacaine; D004837:Epinephrine