Transnasal butorphanol is effective for postoperative pain relief in children undergoing myringotomy

Background: More than 70% of children require analgesics after bilateral myringotomy and tube placement (BMT). Because anesthesia for BMT is generally provided by face mask without placement of an intravenous catheter, an alternative route for analgesia administration is needed. Transnasal butorphanol is effective in relieving postoperative pain in adults and children. The effectiveness of transnasal butorphanol for postoperative pain management in children undergoing BMT was studied. Methods: This double-blinded, placebo-controlled study compared the postoperative analgesic effects of transnasal butorphanol administered after the induction of anesthesia. Sixty children classified as American Society of Anesthesiologists physical status 1 or 2 who were aged 6 months or older and scheduled for elective BMT were randomized to receive transnasal placebo or 5, 15, or 25 mu g/kg butorphanol, Postoperative pain was assessed using the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) on arrival in the postanesthesia care unit and at 5, 10, 15, 30, 45, and 60 min. Results: The CHEOP scores were significantly less in the 25 mu g/kg transnasal butorphanol group compared with controls. Significantly fewer children received rescue analgesia in the 25 mu g/kg transnasal butorphanol group compared with controls (n = 1 and 8, respectively; P = 0.02). Conclusions: Transnasal butorphanol given in a dose of 25 mu g/kg after induction of anesthesia provided adequate postoperative pain relief in children undergoing BMT.