Caudal epidural butorphanol plus bupivacaine versus bupivacaine in pediatric outpatient genitourinary procedures

C. David Lawhorn, Jo Anne M. Stoner, Michael L. Schmitz, Raeford E. Brown, Frank W. Stewart, Paula Volpe, Robert Shirey

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Study Objective: To investigate the efficacy of adding butorphanol to bupivacaine administered in the caudal epidural space in children undergoing genitourinary (GU) procedures. Design: Randomized, double-blinded, controlled study. Setting: University affiliated pediatric hospital. Patients: 200 ASA physical status I and II male patients between 6 months and 10 years of age. Interventions: Patients were randomized to receive either 0.25% bupivacaine with 1: 200,000 epinephrine alone (Group 1) or 0.25% bupivacaine with 1:200,00 epinephrine plus 30 μg/kg butorphanol (Group 2) administered via the caudal epidural space prior to surgical incision. Measurements and Main Results: Patients were evaluated postoperatively until discharge. Measurements included requirement of additional analgesic, sedation, pain/comfort scores, and a 24-hour analgesic follow-up. Significantly fewer patients in the butorphanol group required rescue morphine sulfate in the postanesthesia care unit (p ≤ 0.001). The total number of morphine doses administered to Group 2 was significantly less than Group 1 (p ≤ 0.001). 52% of patients in Group 1 compared with 28% in Group 2 required administration of additional analgesics following discharge from the hospital (p ≤ 0.003), with 23% of Group 1 requiring a codeine compound compared with 8% in Group 2 (p < 0.03). Conclusions: The addition of 30 μg/kg butorphanol to 0.25% bupivacaine with epinephrine via the caudal epidural space is a safe, effective means to increase duration of analgesia following GU procedures.

Original languageEnglish (US)
Pages (from-to)103-108
Number of pages6
JournalJournal of Clinical Anesthesia
Issue number2
StatePublished - Mar 1997
Externally publishedYes


  • Anesthesia, outpatient, pediatric
  • bupivacaine
  • butorphanol, caudal epidural
  • hernia, pediatric

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine


Dive into the research topics of 'Caudal epidural butorphanol plus bupivacaine versus bupivacaine in pediatric outpatient genitourinary procedures'. Together they form a unique fingerprint.

Cite this