Abstract
Epidural butorphanol 1, 2 and 4 mg were compared with morphine, 5 mg, for postoperative analgesia in 92 consenting, healthy, term parturients who had undergone Caesarean section under epidural lidocaine anaesthesia in a randomized double-blind study. Postoperative pain was assessed using a visual analogue scale and recorded with heart rate, blood pressure and respiratory rate. The demographic characteristics, and the incidences of primary and repeat Caesarean sections, were not different among the four treatment groups. At 15, 30, 45 and 60 min after treatment the median pain scores following butorphanol were similar and lower than those following morphine (P < 0.05). Calculated median percentage pain relief values for butorphanol were higher than morphine at each of these times (P < 0.05). At 90 min and 2 hr the pain scores and pain relief values were similar. Beyond 45 min the number of patients requesting supplemental medication and dropping out of the study increased progressively in both the butorphanol and morphine treated patients. The attrition profiles for butorphanol were different from morphine (P < 0.01). The median time in the study was > 24 hr for morphine, and 3, 2.5 and 4 hr for butorphanol, 1, 2 or 4 mg, respectively. No patient developed a clinically important change in heart rate or blood pressure, and none experienced a decrease in respiratory rate below 12 breaths · min−1. One of 69 patients (1.4 per cent) who received butorphanol developed pruritus compared with ten (43 per cent) of 23 patients who received morphine. The global assessments of the adequacy of analgesia were indistinguishable between morphine and butorphanol. Epidural butorphanol provides safe, effective postoperative analgesia, has a prompt onset, and a limited duration.
Résumé
Dans une étude à double insu lors de césarienne chez 92 parturientes à terme, nous avons comparé l’efficacité de 1, 2 et 4 mg de butorphanol à celle de 5 mg de morphine injectés dans le cathéter employé pour l’anesthésie épidurale à la lidocaïne. Nous jaugions la douleur postopératoire sur une échelle visuelle analogue et mesurions le pouls, la tension artérielle et la fréquence respiratoire. Les variables démographiques et la proportion de césariennes itératives étaient semblables dans les quatre groupes. Les valeurs médianes d’intensité douloureuse 15, 30, 45 et 60 min après l’injection de butorphanol étaient les mêmes pour les trois doses et étaient inférieures à celle de la morphine (P < 0,05); en même temps, les pourcentages médians de soulagement étaient plus grands avec le butorphanol qu’avec la morphine (P < 0,05). Toutefois, à 90 min et 2 h post injection, ces variables étaient les mêmes pour les deux morphiniques. A partir de la 45ième minute, de plus en plus de patientes traitées à la morphine ou au butorphanol nécessitaient d’autres analgésiques, mettant ainsi un terme à leur participation à l’étude mais à une fréquence différente selon le morphinique (P < 0,01). La durée médiane de participation à l’étude était de plus de 24 h pour la morphine et de 3, 2,5 et 4 h pour les doses de 1, 2 et 4 mg de butorphanol respectivement. Il n’y eut pas de modification clinique du pouls ou de la tension artérielle non plus que de bradypnée à moins de 12 min−1. Une seule des 69 patientes (1,4 pour cent) ayant reçu du butorphanol se plaint de prurit mais 10 des 23 patientes (43 pour cent) du groupe morphine firent de même. L’évaluation globale de l’efficacité analgésique était la même pour la morphine et le butorphanol. Le butorphanol épidural offre une analgésie postopératoire sûre et efficace; il agit rapidement et pendant une période limitée.
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Palacios, Q.T., Jones, M.M., Hawkins, J.L. et al. Post-caesarean section analgesia: a comparison of epidural butorphanol and morphine. Can J Anaesth 38, 24–30 (1991). https://doi.org/10.1007/BF03009159
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DOI: https://doi.org/10.1007/BF03009159