Epidural morphine with butorphanol in pediatric patients.

STUDY

OBJECTIVE

To determine whether the addition of butorphanol to epidural morphine is effective in reducing the frequency of side effects caused by neuraxial opioids.

DESIGN

Randomized, double-blind study.

SETTING

Large tertiary care pediatric hospital.

PATIENTS: 20 children between the ages of 2 and 17 years undergoing spinal, abdominal, or thoracic procedures.

INTERVENTIONS: 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).

MEASUREMENTS AND MAIN

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%.

CONCLUSION

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.