CAUDAL EPIDURAL BUTORPHANOL PLUS BUPIVACAINE VERSUS BUPIVACAINE IN PEDIATRIC OUTPATIENT GENITOURINARY PROCEDURES

Study Objective: To investigate the efficacy of adding butorphanol to bupivacaine administered in the caudal epidural space in children unde rgoing genitourinary (GU) procedures. Design: Randomized, double-blind ed, controlled study. Setting: University affiliated pediatric hospita l. Patients: 200 ASA physical status I and II male patients between 6 months and 10 years of age. Interventions: Patients were randomized to receive either 0.25% bupivacaine with 1:200,000 epinephrine alone (Gr oup 1) or 0.25% bupivacaine with 1:200,000 epinephrine plus 30 mu g/kg butorphanol (Group 2) administered via the caudal epidural space prio r to surgical incision. Measurements and Main Results: Patients were e valuated postoperatively until discharge. Measurements included requir ement of additional analgesic, sedation, pain/comfort scores, and a 24 -hour analgesic follow-up. Significantly fewer patients in the butorph anol group required rescue morphine sulfate in the postanesthesia care unit (P less than or equal to 0.001). The total number of morphine do ses administered to Group 2 was significantly less than Group 1 (p les s than or equal to 0.001). 52% of patients in Group 1 compared with 28 % in Group 2 required administration of additional analgesics followin g discharge from the hospital (p less than or equal to 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 mu g/kg butorphanol to 0.2 5% bupivacaine with epinephrine via the caudal epidural space is a saf e, effective means to increase duration of analgesia following GU proc edures. (C) 1997 by Elsevier Science Inc.