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Butorphanol: an opioid for day-care paediatric surgery

Abstract

The purpose of this study was to compare the side effects and efficacy of equianalgesic doses of morphine (M) and butorphanol (B) in children undergoing similar surgical procedures associated with moderate postoperative pain. We studied 156 healthy children aged 1.5–13 yr who underwent elective inguinal herniorrhaphy or orchidopexy. After induction of anaesthesia subjects were given 150 μg · kg−1 M or 30 μg · kg−1 B following a randomized, stratified, blocked and double-blind design. A standardized anaesthetic was administered, which included 1.5% halothane, vecuronium, droperidol and mechanical ventilation. The postsurgical four-hour follow-up included assessment of pain, vomiting and respiratory depression. Pain was assessed with mCHEOPS and analgesics were administered when indicated in the recovery room. Each opioid was administered to a group of 78 patients. Within each group, 25 subjects had an iv induction, 21 children had an orchidopexy and 57 had inguinal hernia repairs. The groups were similar with respect to age, weight, and length of surgery. The choice of opioid did not affect recovery times from anaesthesia. Analgesic requirements were similar among the groups. Ten minutes after arrival in the recovery room the B-subjects had a lower pain score than the M-patients. Postoperative vomiting was less among the B-subjects: 14% vs 28%, P = 0.03. Two M-patients required an unscheduled admission to hospital because of vomiting. It is concluded that butorphanol has few advantages over morphine in the population studied.

Résumé

Cette étude vise à comparer les effets secondaires et l’efficacité de doses analgésiques équivalentes de morphine (M) et de butorphanol (B) chez les enfants soumis à des interventions chirurgicales de même type associées à des douleurs d’intensité modérée. L’étude porte sur 156 enfants bien portants âgés de 1,5 à 13 ans soumis à une hemiorraphie inguinale ou à une orchidopexie non urgentes. Après l’induction de l’anesthésie, les sujets reçoivent M, 150 μg kg−1 ou B, 30 μg · kg−1 selon la méthode des blocs répartis au hasard et à double insu. Une anesthésie standard est réalisée avec ventilation mécanique, halothane 1,5% vécuronium et dropéridol. Le suivi postopératoire de quatre heures comprend l’évaluation de la douleur, de l’incidence des vomissements et de la dépression respiratoire. La douleur est évaluée avec mCHEOPS et les analgésiques administrés à la salle de réveil lorsque nécessaire. Chacun des morphiniques est administré à un groupe de 78 patients. A l’intérieur de chaque groupe, 25 sujets reçoivent une induction intraveineuse, 21 patients subissent une orchidopexie et 57, une cure de hernie inguinale. Les groupes s’équivalent pour l’âge, le poids et la durée de la chirurgie. Le choix de l’anesthésique n’a aucune influence sur la durée de la récupération. Les besoins analgésiques sont les mêmes entre les groupes. Dix minutes après leur arrivée en salle de réveil, les sujets du groupe B ont des scores de douleur inférieurs à ceux du groupe M (14% vs 28% P = 0,03). Deux patients du groupe M doivent être réadmis à l’hôpital en raison de vomissements. En conclusion, le butorphanol offre peu d’avantages sur la morphine pour la population étudiée.

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Correspondence to William M. Splinter.

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Splinter, W.M., O’Brien, H.V. & Komocar, L. Butorphanol: an opioid for day-care paediatric surgery. Can J Anaesth 42, 483 (1995). https://doi.org/10.1007/BF03011685

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Key words

  • anaesthesia: paediatric
  • analgesia: postoperative
  • analgesics: butorphanol, morphine
  • vomiting: postoperative