Caudal epidural butorphanol plus bupivacaine versus bupivacaine in pediatric outpatient genitourinary procedures.
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.
Lawhorn
C D
CD
Division of Pediatric Anesthesia, Arkansas Children's Hospital, Little Rock, USA.
Stoner
J M
JM
Schmitz
M L
ML
Brown
R E
RE
Stewart
F W
FW
Volpe
P
P
Shirey
R
R
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
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D002077:Butorphanol; D002045:Bupivacaine; D004837:Epinephrine