EPIDURAL BUTORPHANOL DOES NOT REDUCE SIDE-EFFECTS FROM EPIDURAL MORPHINE AFTER CESAREAN BIRTH

In this prospective, double-blind, randomized study of women undergoin g elective cesarean birth, the hypothesis that epidural butorphanol in various doses could effectively reduce or eliminate the side effects caused by epidural morphine was tested. Patients were randomly assigne d to one of four groups. All received a standard epidural anesthetic a nd 20 min after delivery each received 3 mg epidural morphine with eit her 1 mg butorphanol (Group A), 2 mg butorphanol (Group B), 3 mg butor phanol (Group C), or 3 mL normal saline (Group D). Patient evaluations were made preoperatively and 2, 8, and 24 h after delivery. These con sisted of visual analog scores for pain, satisfaction, nausea, itch, a nd somnolence. At each evaluation, a CO2 challenge test, using portabl e equipment, was performed. Data from 71 patients were analyzed and al l four groups were comparable in terms of age, height, weight, level o f sensory block, and volume of local anesthetic used. There were no si gnificant differences among groups in terms of pain, satisfaction, nau sea, or pruritus. Groups A, B, and C had significantly higher somnolen ce scores at 8 h compared to Group D (P < 0.001). There were no signif icant differences among groups in CO2 challenge test data at any point during the study, but overall a reduced sensitivity to CO2 after opio id administration was observed across all groups. There were no clinic ally; significant incidents of respiratory depression. Epidural butorp hanol, in doses of 1-3 mg, failed to reduce the side effects from 3 mg epidural morphine given after cesarean birth. Patients who received e pidural butorphanol reported significantly higher levels of somnolence .