Transnasal butorphanol for postoperative analgesia following paediatric surgery in a Third World country

The authors present their experience with transnasal butorphanol to provide analgesia following orthopaedic and plastic surgical procedures in children. Transnasal butorphanol was administered to eight patients ranging in age from eight to 17 years and in weight from 34 to 64 kg. Following the surgical procedure, the patient and a parent were instructed on how to use the medication. They were instructed to administer one spray into one nostril every three h as needed for pain. The quality of analgesia was assessed twice a day using a visual analogue score of 0 to 10 (0 = no pain, 10 = worst pain imaginable). Intranasal butorphanol provided adequate analgesia in all eight patients with visual analogue scores of zero to two. Adverse effects from the medication included one report of nausea, one complaint of transient dizziness, and two reports of a bitter taste and some mild throat irritation. None of these was severe enough to preclude its subsequent use. Our preliminary experience suggests that transnasal butorphanol may offer an alternative route of delivery when intravenous administration is not feasible. Future studies are needed to compare its efficacy to intravenous and non-parenteral routes of administration. It may prove to be useful in other situations when intravenous access is lacking such as prior to invasive procedures in the outpatient clinic or emergency room.