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Epidural pain management in the postrhizotomy patient
1Arkansas Children's Hospital, Little Rock 72202-3591.
Insights
Adding butorphanol to epidural morphine significantly reduced side effects in children undergoing rhizotomy. This combination therapy improved parent satisfaction without compromising pain relief or causing excessive sedation.
Area of Science:
- Pediatric Anesthesiology
- Pain Management
- Pharmacology
Background:
- Epidural morphine is commonly used for post-operative analgesia in children undergoing rhizotomy.
- Significant side effects, including nausea, vomiting, pruritus, urinary retention, and respiratory depression, occur in up to 50% of patients receiving epidural morphine alone.
- Optimizing analgesia while minimizing adverse events is crucial for pediatric surgical care.
Purpose of the Study:
- To evaluate the efficacy and safety of combining epidural butorphanol with epidural morphine in pediatric patients undergoing rhizotomy.
- To determine if butorphanol addition reduces the incidence of common morphine-related side effects.
- To assess the impact on overall analgesia, sedation, and parent satisfaction.
Main Methods:
- A randomized, double-blind, prospective study was conducted.
- Participants were children undergoing rhizotomy.
- Two groups were compared: epidural morphine (80 µg/kg) versus epidural morphine (80 µg/kg) plus butorphanol (40 µg/kg).
Main Results:
- The addition of butorphanol to epidural morphine virtually eliminated side effects such as nausea, vomiting, pruritus, urinary retention, and respiratory depression.
- Analgesia was effectively maintained.
- No undue sedation was observed.
- Parent satisfaction exceeded 90%.
Conclusions:
- Combined epidural morphine and butorphanol provide superior side effect reduction compared to epidural morphine alone in pediatric rhizotomy patients.
- This combination therapy represents a safe and effective strategy for pediatric post-operative pain management.
- Enhanced patient and parent satisfaction can be achieved with this optimized analgesic approach.
Abstract:
The authors report a randomized double-blind prospective study comparing epidural morphine 80 micrograms/kg to epidural morphine 80 micrograms/kg plus butorphanol 40 micrograms/kg in children undergoing rhizotomy. Up to 50% of children receiving epidural morphine alone will experience side effects of nausea, vomiting, pruritus, urinary retention or respiratory depression. The addition of the narcotic agonist-antagonist butorphanol virtually eliminated these side effects without compromising analgesia or causing undue sedation. Parent satisfaction was greater than 90%.