PATIENT CONTROLLED EPIDURAL ANALGESIA (PCEA) WITH BUPRENORPHINE AND DROPERIDOL IN CHILDREN

Abstract

S228 Epidural administration of droperidol has been shown to enhance the analgesic effect of epidural morphine with reduced adverse effects in adults [1]. Epidural buprenorphine is being used to provide postsurgical pain control [2]. The present study assessed whether the addition of epidural droperidol would influence the effect of epidural buprenorphine by Patient Controlled Epidural Analgesia (PCEA) in pediatric patients. METHOD: Forty children of ASA class I-II and age 5-11 who were scheduled for lower extremity surgeries received placement of epidural catheter at L2-4 after ketamin 5 mg/kg I.M. Epidural anesthesia was maintained with 1.5% lidocaine. After surgery when patients were fully awake and complained of pain they were divided in double blind and randomized fashion innnto 2 equal groups with Group A receiving PCEA of buprenophine 0.0012% in bupivacaine 0.1% and Group B receiving PCEA of buprenorphine 0.0012% + droperidol 0.005% + bupivacaine 0.1%. The PCEA was administered by Graseby-9300 pump with a loading dose of 0.1 ml/kg, continuous infusion of 0.05 ml/kg/hr and a PCA dose of 0.05 ml/kg with a 30 min lock out interval. Vital signs, pain intensity assessment by faces pain scale [3], sedation by Ramsay scale [4], frequency and dose of PCEA and adverse effects were recorded for 24 hr. post operatively. RESULT: The demographic data of the 2 groups were comparable without significant difference. Both groups obtained effective pain relief with an average value of the summed VAS 1.7 for Group A and 1.5 for Group B. However, Group B had significantly lower number of PCEA doses 1.44 +/- 0.18 vs 2.65 +/- 0.38) and less total 24 hr. dose used than those of Group B (13.23 +/- 3.26 ml vs 20.38 +/- 5.35 ml) (p<0.01). This seems to indicate that there is a potentiating effect of the epidural buprenorphine analgesia by droperidol. The incidence of nausea/vomiting was found to be 5/20 in Group A vs 1/20 in Group B. Patients in Group B showed a higher sedation score of 3.7 +/- 0.62 vs 2.7 +/- 0.45 in Group A (p<0.05). Urinary retention was not assessed due to the use of indwelling Foley catheters in some of the patients and there was no other significant adverse reactions observed. DISCUSSION: The addition of epidural droperidol appears to potentiate the analgesic effect and reduce the adverse effect of epidural burenorphine which can be used safely to provide effective relief of post surgical pain by PCEA method in children.