title: Continuous epidural butorphanol relieves pruritus associated with epidural morphine infusions in children.
abstract: We examined the efficacy of epidural butorphanol to either prevent or relieve pruritus associated with epidural morphine infusion in children. Forty-six children were randomized to receive either epidural morphine (M) or epidural M with butorphanol (B) for postoperative analgesia. They received bupivacaine and either M 50 microg.kg-1 or the same dose of M plus B 10 microg.kg-1. Following surgery, a continuous infusion of 0.1% bupivacaine with either M 20 microg.ml-1 or M 20 microg.ml-1 + B 4 microg.ml-1 was given at a rate of 0.3 ml.kg-1.h-1. Pain scores and pruritus scores were recorded every 4 h during epidural infusion. Subjects with a pruritus score=2 received diphenhydramine 0.5 mg.kg-1 i.v. and were switched to an alternate epidural infusion; subjects receiving M (group M) were switched to M+B while subjects receiving M+B (group B) were switched to hydromorphone (H) 4 microg.ml-1. There was no difference in the initial incidence of pruritus (group M 11/18; group B 13/28). No subject in group M required a second change of epidural infusion because of continued pruritus after being switched to M+B; five of 13 subjects in group B continued to experience pruritus after being switched to H and required a second change of epidural infusion or an alternate analgesic modality (P=0.038). The median pruritus score in the first 24 h after changing epidural infusions was 0 in subjects in group MDelta (changed from M to M+B) and 1 in subjects in group BDelta (changed from M+B to H; P=0.012). While the median sedation score in the first 24 h was 1 in both groups, there was a greater incidence of sedation scores of 2 in group B than group M (28% vs 12.3%; P=0.021). B 10 microg.kg-1 was not effective in preventing pruritus associated with bolus epidural administration of M 50 microg.kg-1 in children. B 1.2 microg.kg-1. h-1 was effective in relieving pruritus associated with continuous epidural infusion of M 6 microg.kg-1.h-1.
authors.affiliation: Department of Anesthesiology, University of Cincinnati, Cincinnati, Ohio, USA.
authors.forename: J B
authors.initials: JB
authors.lastname: Gunter
authors.forename: J
authors.initials: J
authors.lastname: McAuliffe
authors.forename: T
authors.initials: T
authors.lastname: Gregg
authors.forename: N
authors.initials: N
authors.lastname: Weidner
authors.forename: A M
authors.initials: AM
authors.lastname: Varughese
authors.forename: D M
authors.initials: DM
authors.lastname: Sweeney
mesh_terms: D000293:Adolescent; D015360:Analgesia, Epidural / Q000009:adverse effects*; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D000779:Anesthetics, Local / Q000627:therapeutic use; D000982:Antipruritics / Q000008:administration & dosage / Q000627:therapeutic use*; D002045:Bupivacaine / Q000627:therapeutic use; D002077:Butorphanol / Q000008:administration & dosage / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D003243:Consciousness / Q000187:drug effects; D018592:Cross-Over Studies; D004155:Diphenhydramine / Q000627:therapeutic use; D004311:Double-Blind Method; D005500:Follow-Up Studies; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D004091:Hydromorphone / Q000627:therapeutic use; D015994:Incidence; D007268:Injections, Epidural; D009020:Morphine / Q000008:administration & dosage / Q000009:adverse effects*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy; D011446:Prospective Studies; D011537:Pruritus / Q000517:prevention & control*
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000982:Antipruritics; D006634:Histamine H1 Antagonists; D009020:Morphine; D004155:Diphenhydramine; D004091:Hydromorphone; D002077:Butorphanol; D002045:Bupivacaine