Addition of Butorphanol Reduces the Degree of Pruritus in Pain-controlled Patients by Epidural Morphine

Lee, Jong Nam; Cho, In Chan; Park, Young Chul

Abstract

BACKGROUND: Nowadays, epidural morphine is commonly used in postoperative pain control. But epidural morphine may produce some side-effects, e.g. pruritus, nausea, vomiting, urinary retention and respiratory depression. Especially, pruritus is the most common complaint in pain-controlled patients by epidural morphine. So we evaluated whether addition of epidural butorphanol affects the degree of pruritus and pain score in pain controlled patients who by epidural morphine after hysterectomy.
METHODS
Group l (N=15) received postoperative epidural 0.1% bupivacaine 100ml plus morphine 10mg, group 2 (N=15) received the mixture of butorphanol 2mg with same regime as in group 1, group 3 (N=15) received the mixture of butorphanol 4mg with same regime as in group l. All of the three groups received these solutions by infusion pump, l ml /hour, for postoperative 4 days. All groups received additional morphine 1.2 mg in 0.2% bupivacaine 6 ml epidurally when the peritoneum was closed under general anesthesia. The severity of pain, pruritus, nausea and vomiting was estimated by 10cm VAS (visual analogue scale) and somnolence by positive or negative during postoperative 4 days.
RESULTS
Severity of pruritus, but not nausea and vomiting was decreased in group 2 and 3 compared with group 1 (p<0.05). Pain score was increased in group 3 at postoperative day (POD) 0 and 2 compared with group 1 (p<0.05). Incidence of somnolence in group 1, 2 and 3 were 2.7+/-0.7, 5.3+/-0.7 and 10.0+/-1.0 respectively.
CONCLUSIONS
These results suggest that butorphanol reduce the degree of pruritus, the most common side effect of morphine, but increase the incidence of somnolence.