Altering Epidural Morphine Side Effects with Butorphanol in Children

Abstract

In Response: We thank Drs. Lawhorn and Schmitz for their interest and close perusal of our article. We are in agreement that epidural butorphanol offers benefits to some children receiving epidural morphine. Our hypothesis was that an agonist/antagonist would prevent undesirable side effects of epidural morphine. Our data did not support this. The actual incidence of pruritis, vomiting, urinary retention, and respiratory depression was not significantly different among the three groups. The numbers of patients without nasogastric tubes and urinary catheters were small; the fact that these patients experienced vomiting and urinary retention after butorphanol supports our contention that, with this dose, side effects are not prevented. The overall incidence of pruritis was not prevented, only reduced in its severity. We agree that this has its merits. The sedation is not a side effect of the morphine. This is a well-recognized effect of butorphanol. We agree that this is advantageous in some children, but our conclusions addressed attempting to reduce the epidural morphine side effects. We do not feel that we were biased in our conclusions. Correctly stated, the addition of butorphanol did not decrease the incidence of side effects attributed to epidural morphine. It did, however, add a beneficial side effect of its own, sedation! Ann Bailey, MD Robert D. Valley, MD Eugene B. Freid, MD Pauletta Calhoun, RN Department of Anesthesiology, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7010