Transnasal butorphanol is effective for postoperative pain relief in children undergoing myringotomy.
BACKGROUND
More than 70% of children require analgesics after bilateral myringotomy and tube placement (BMT). Because anesthesia for BMT is generally provided by face mask without placement of an intravenous catheter, an alternative route for analgesia administration is needed. Transnasal butorphanol is effective in relieving postoperative pain in adults and children. The effectiveness of transnasal butorphanol for postoperative pain management in children undergoing BMT was studied.


METHODS
This double-blinded, placebo-controlled study compared the postoperative analgesic effects of transnasal butorphanol administered after the induction of anesthesia. Sixty children classified as American Society of Anesthesiologists physical status 1 or 2 who were aged 6 months or older and scheduled for elective BMT were randomized to receive transnasal placebo or 5, 15, or 25 microg/kg butorphanol. Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) on arrival in the postanesthesia care unit and at 5, 10, 15, 30, 45, and 60 min.


RESULTS
The CHEOP scores were significantly less in the 25 microg/kg transnasal butorphanol group compared with controls. Significantly fewer children received rescue analgesia in the 25 microg/kg transnasal butorphanol group compared with controls (n = 1 and 8, respectively; P = 0.02).


CONCLUSIONS
Transnasal butorphanol given in a dose of 25 microg/kg after induction of anesthesia provided adequate postoperative pain relief in children undergoing BMT.
Department of Anesthesia, Indiana University School of Medicine, Indianapolis 46202-5200, USA. rbennie@iupui.edu
R E
RE
Bennie
L A
LA
Boehringer
S F
SF
Dierdorf
M P
MP
Hanna
L J
LJ
Means
D000281:Administration, Intranasal; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D002077:Butorphanol / Q000008:administration & dosage / Q000627:therapeutic use*; D002648:Child; D002675:Child, Preschool; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010147:Pain Measurement / Q000187:drug effects; D010149:Postoperative Pain / Q000188:drug therapy*; D014432:Tympanic Membrane / Q000601:surgery*
D000701:Analgesics, Opioid; D002077:Butorphanol