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Objective:To evaluate the analgesic effect and adverse reactions of butorphanol after stopping patient controlled intravenous analgesia (PCIA) pump in cesarean section.Methods:One hundred and twenty patients with cesarean section in Tongji Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from March 20, 2021 to December 8, 2021 were divided into three groups as follows: butorphanol group, diclofenac sodium suppository group and control group and there were 40 patients in each group. The vital signs, analgesic effect and adverse reactions among the three groups were compared. Meantime, the bladder and gastrointestinal function recovery and neonatal jaundice in three groups were also compared.Results:The visual analogue score (VAS) in butorphanol group was significantly lower than that of control group at 3 and 4 h after stopping PCIA pump: (2.16 ± 0.09) scores vs. (2.72 ± 0.25) scores, (2.21 ± 0.10) scores vs. (2.72 ± 0.21) scores, P< 0.05, but there was no significant difference in VAS at 6 and 12 h after stopping PCIA pump. VAS in diclofenac sodium suppository group was significantly lower than that of control group at 3 h after stopping PCIA pump: (2.06 ± 0.10) scores vs. (2.16 ± 0.09) scores, P<0.05, but there was no significant difference in VAS at 4, 6 and 12 h ( P>0.05). The 3 h VAS of butorphanol group was lower than that of diclofenac sodium suppository group, but the difference was not statistically significant ( P>0.05). The VAS of butorphanol group was lower than that of diclofenac sodium suppository group at 4 h after operation: (2.21 ± 0.10) scores vs. (2.56 ± 0.12) scores, and the difference was statistically significant ( P<0.05). The first time of getting out of bed and urination time in butorphanol group were later than diclofenac sodium suppository group and control group: (28.32 ± 1.36) h vs. (25.94 ± 0.92) h and (24.50 ± 0.64) h, (29.05 ± 1.67) h vs. (26.76 ± 1.05) h and (25.06 ± 0.65) h, and the difference was statistically significant ( P<0.05). While the anal exhaust time in diclofenac sodium suppository group was delayed, but the difference was not statistically significant ( P>0.05). Conclusions:The analgesic effect of butorphanol is better than diclofenac sodium suppository after stopping PCIA pump in cesarean section, but nursing care should be strengthened to urge patients to take early activities to reduce the occurrence of urinary retention.
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Objective:To observe the effect of preoperative application of butorphanol tartrate on postoperative recovery quality in patients undergoing thoracoscopic lobectomy.Methods:A prospective selection was conducted on 96 lung cancer patients who underwent thoracoscopic lobectomy and were admitted to Linyi People′s Hospital from May 2021 to September 2021. They were randomly divided into observation group and control group using a random table number method, with 48 patients in each group. The observation group received intravenous injection of 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction; The control group was given an equal volume of physiological saline. The operation site, operation time, remifentanil dosage during operation, heart rate (HR) and mean arterial pressure (MAP) at each time point of admission (T 0), intubation (T 1), 5 min after intubation (T 2), extubation (T 3), 5 min after extubation (T 4), and 15 min into post-anaesthesia care unit (PACU) (T 5) were recorded; The awakening Restlessness score (RS), Ramsay score, Visual Analogue Scale (VAS) score at T 4 and T 5, the time required from completion to extubation, and postoperative anesthesia related adverse reactions were evaluated. Results:There was no significant difference in the operation site, operation time and remifentanil dosage between the two groups (all P>0.05). Compared with T 0, the HR at T 2, T 3 and T 4, MAP at T 1, T 2, T 3 and T 4 in the two groups decreased significantly (all P<0.05). The HR of the observation group at T 1 and T 3 was significantly lower than that of the control group, and the difference was statistically significant (all P<0.05). The VAS scores of T 4 and T 5 in the observation group were lower than those in the control group after surgery, while the Ramsay score were higher than those in the control group (all P<0.001). The incidence of postoperative restlessness, nausea and vomiting in the observation group was lower than that in the control group ( P<0.05). Conclusions:Administering 0.02 mg/kg butorphanol tartrate 15 minutes before anesthesia induction can improve the quality of recovery in patients undergoing thoracoscopic lobectomy, reduce restlessness and related adverse reactions during recovery.
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Objective:To observe the effects of esketamine combined with butorphanol in endotracheal intubation guided by fiberoptic bronchoscopy with spontaneous breathing.Methods:Forty patients suspected of having difficult airways during elective general anesthesia operations in Hunan Provincial People′s Hospital were prospectively selected and divided into control group and observation group by random number table. Propofol plus sufentanil, esketamine plus butorphanol were used for intravenous general anesthesia respectively. At the same time, they were assisted with cricothyroid puncture and surface anesthesia of nasopharynx and larynx, and then trachea intubation with spontaneous breathing was performed through the nose under the guidance of fiberoptic bronchoscope. The changes of heart rate (HR), mean arterial pressure (MAP), arterial partial pressure of oxygen (PaO 2), and the levels of serum cortisol, norepinephrine and adrenaline before and after endotracheal intubation were compared between the two groups. The number of body motions and coughing at the completion of endotracheal intubation was compared between the two groups. Results:In the control group, the HR and MAP at the completion of intubation were higher than those before intubation, and the PaO 2 was lower than those before intubation (all P<0.05); In the observation group, there was no significant difference in HR, MAP and PaO 2 at the completion of intubation and before intubation (all P>0.05). The HR and MAP at the end of intubation in the observation group were lower than those in the control group, and the PaO 2 was higher than that in the control group (all P<0.05). The number of body motion and coughing in the observation group was significantly less than that in the control group at the completion of endotracheal intubation (all P<0.01). At the end of endotracheal intubation, the serum cortisol, norepinephrine and epinephrine level in the observation group were significantly lower than those in the control group (all P<0.01). Conclusions:Esketamine combined with butorphanol has advantages over propofol combined with sufentanil in the application of fiberoptic bronchoscopy guided tracheal intubation in difficult airways that retain spontaneous breathing, and can better control the stress response caused by tracheal intubation.
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Objective:To investigate the effect of dexmedetomidine combined with butorphanol on perioperative analgesia in patients subjected to cardiac surgery.Methods:Sixty-three patients who underwent elective cardiac surgery in Weihai Central Hospital from June 2019 to August 2020 were included in this study. They were divided into propofol + sufentanil group ( n = 21), dexmedetomidine + sufentanil group ( n = 23) and dexmedetomidine + butorphanol group ( n = 19) according to different analgesic methods. Postoperative analgesic satisfaction, Visual Analogue Scale score, hemodynamic changes (heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure) and adverse reactions were compared among the three groups. Results:The satisfaction rate of postoperative analgesia in the dexmedetomidine + butorphanol group was 94.7% (18/19), which was significantly higher than 61.9% (13/21) in the propofol + sufentanil group and 60.8% (14/23) in the dexmedetomidine + sufentanil group ( χ2 = 6.16, 6.57, both P < 0.05). At 4, 12, 24 and 48 hours after tracheal extubation, Visual Analogue Scale score in the dexmedetomidine + butorphanol group were significantly lower than that in the propofol + sufentanil group and dexmedetomidine + sufentanil group (both P < 0.05). At the time of tracheal extubation and at 5 minutes after tracheal extubation, heart rate, respiratory rate, systolic blood pressure and diastolic blood pressure in the dexmedetomidine+butorphanol group were significantly lower than those in the propofol + sufentanil group and dexmedetomidine + sufentanil group (both P < 0.05). The incidence of adverse reactions in the dexmedetomidine + butorphanol group was 10.5% (2/19), which was significantly lower than 23.8% (5/21) in the propofol + sufentanil group and 30.43% (7/23) in the dexmedetomidine + sufentanil group [30.4% (7/23), χ2=21.94, P < 0.001]. Conclusion:Dexmedetomidine combined with butorphanol in cardiac surgery can not only stabilize postoperative blood pressure and heart rate, but also lower the degree of pain and is highly safe.
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Objective:To investigate the analgesic effects of butorphinol used in intravenous patient-controlled analgesia after laparoscopic gynecological surgery.Methods:Ninety-eight patients who underwent laparoscopic gynecological surgery in Linhai First People's Hospital between March 2018 and November 2019 were included in this study. They were randomly divided into control and observation groups, with 49 patients per group. After surgery, intravenous patient-controlled analgesia with either ondansetron (control group) or ondansetron combined with butorphanol (observation group). At 2, 12 and 24 hours after surgery, visual analogue scale score and Ramsay sedation scale score were compared between the two groups. Heart rate, systolic blood pressure, and respiratory rate at 0 and 30 minutes after surgery were compared between the two groups. The incidences of postoperative adverse reactions were compared between the two groups.Results:At 2, 12 and 24 hours after surgery, visual analogue scale scores in the observation group were (1.27 ± 0.50) points, (2.24 ± 0.63) points, and (1.71 ± 0.55) points respectively, which were significantly lower than (1.52 ± 0.47) points, (3.20 ± 0.58) points, (2.23 ± 0.59) points in the control group ( t = 2.55, 7.84, 4.51, all P < 0.05). At 2, 12 and 24 hours after surgery, Ramsay sedation scale scores in the observation group were (4.22 ± 0.41) points, (3.22 ± 0.43) points, and (3.02 ± 0.31) points, respectively, which were significantly higher than (4.02 ± 0.32) points, (3.01 ± 0.27) points, (2.73 ± 0.35) points in the control group ( t = -2.69, -2.89, -4.34, all P < 0.05). There were no significant differences in heart rate, systolic blood pressure, and respiratory rate measured at 0 and 30 minutes after surgery between the two groups (all P > 0.05). There were no significant differences in use of pethidine and the incidence of adverse reactions between the two groups (both P > 0.05). Conclusion:Butorphinol helps improve the analgesic and sedative effects after laparoscopic gynecological surgery and has little impact on patient's breathing and circulation.
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Objective:To evalaute the efficacy of butorphanol mixed with different doses of hydromorphone in improving patient-controlled intravenous analgesia (PCIA) after secondary cesarean section.Methods:Two hundred American Society of Anesthesiologists physical status Ⅱsingleton pregnant parturients, aged 18-45 yr, at 37-42 week gestation, with body mass index≤30 kg/m 2, undergoing elective secondary cesarean section under combined spinal-epidural anesthesia, were allocated to one of 4 groups ( n=50 each) using a random number table method: butorphanol (group B) and butorphanol mixed with different doses of hydromorphone groups (group BH 1, group BH 2 and group BH 3). Flurbiprofen 50 mg, butorphanol 1 mg and granisetron 3 mg were intravenously injected after delivery during operation.The analgesic pump was connected and turned on at the end of operation.The PCIA solution contained butorphanol 0.24 mg/kg and granisetron 6 mg in group B, butorphanol 0.24 mg/kg and hydromorphone 0.06 mg/kg and granisetron 6 mg in group BH 1, butorphanol 0.24 mg/kg and hydromorphone 0.09 mg/kg and granisetron 6 mg in group BH 2, butorphanol 0.24 mg/kg and hydromorphone 0.12 mg/kg and granisetron 6 mg in group BH 3.The PCIA solution was diluted with normal saline to 150 ml, and the patient-controlled analgesia (PCA) pump was set up to deliver a 3.0 ml bolus dose with a 15-min lockout interval and background infusion at 2.5 ml/h in all the four groups.The degree of pain was evaluated using the VAS score.When the VAS score>5 points after pressuring analgesia pump at rest, flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.VAS scores during movement, at rest and during uterine contraction and observer′s assessment of alertness/sedation scale score were recorded at 3, 6, 24 and 48 h after operation.The requirement for rescue analgesia, effective pressing times of PCA, overall satisfaction score, OAA/S score<5, adverse reactions and time to the first flatus were recorded within 48 h after operation. Results:Compared with group B, VAS scores in different states were significantly decreased after operation, the effective pressing times of PCA were decreased within 48 h after surgery, and the overall satisfaction score was increased in BH 1, BH 2 and BH 3 groups ( P<0.05). Compared with group BH 1, no significant change was found in VAS score in different states after operation in group BH 2 ( P>0.05), and VAS score was significantly decreased at rest after operation in group BH 3 ( P<0.05). There was no significant difference in VAS scores between group BH 2 and group BH 3 ( P>0.05). There were no significant differences in the requirement for rescue analgesia, effective pressing times of PCA and overall satisfaction of the puerperae among BH 1, BH 2 and BH 3 groups ( P>0.05). There was no significant difference in the time to the first flatus after operation, requirement for rescue analgesia and incidence of observe′s assessment of alterness/sedation scale score<5 and adverse reactions among the four groups ( P>0.05). Conclusions:Compared with butorphanol alone, butorphanol mixed with hydromorphone is helpful in reducing maternal pain and improving the overall satisfaction, with fewer adverse reactions.Butorphanol 0.24 mg/kg mixed with hydromorphone 0.09 mg/kg is recommended.
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Objective:To evaluate the effect of butorphanol mixed with ropivacaine for erector spinae plane block (ESPB) on postoperative outcomes in the patients undergoing thoracoscopic pulmonary lobectomy.Methods:Eighty patients of either sex, aged 35-64 yr, with body mass index of 19-30 kg/m 2, of American Society of Anesthesiologists physical status Ⅰ or Ⅱ, undergoing elective thoracoscopic pulmonary lobectomy, were divided into 2 groups ( n=40 each) using a computer-generated random number table method: butorphanol mixed with ropivacaine for ESPB group (group EB) and ropivacaine for ESPB group (group E). ESPB was performed under ultrasound guidance in both groups.A mixture of 0.1% butorphano 1 ml and 0.375% ropivacaine 20 ml was injected in EB group, and 0.375% ropivacaine 20 ml was injected in E group.The other anesthesia methods were the same in the two groups.And target-controlled infusion was stopped and PCIA was performed at the end of skin suture in the two groups.The intraoperative consumption of remifentanil, first time to press an analgesia pump, requirement for rescue analgesia within 24 h after surgery, and occurrence of ESPB-related complications were recorded.Quality of Recovery-40 (QoR-40) scores were recorded at 7 days after surgery.Before induction of anesthesia (T 1) and at 24 h after operation (T 2), the peripheral venous blood samples were collected for determination of plasma interleukin-6 (IL-6) and IL-10 concentrations, and bedside pulmonary function test was performed, and FEV 1/FVC was calculated. Results:Compared with group E, the QoR-40 scores were significantly increased at 7 days after operation, FEV 1/FVC was increased at T 2, the plasma concentrations of IL-10 were decreased at T 2, the plasma concentrations of IL-10 were increased at T 2, the intraoperative consumption of remifentanil was reduced, the first time to press an analgesia pump was prolonged, and the requirement for rescue analgesia within 24 h after surgery was decreased in group EB ( P<0.05). No ESPB-related complications were found in either group. Conclusion:Butorphanol mixed with ropivacaine for ESPB can improve postoperative outcomes in the patients undergoing thoracoscopic pulmonary lobectomy.
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OBJECTIVE：To observe the a nesthetic effect and safety of dexmedetomidine combined with butorphanol for laparoscopic radical resection of colorectal cancer. METHODS ：Totally 180 patients undergoing elective laparoscopic radical resection of colorectal cancer were selected from our hospital during Apr. 2019-May 2020. They were randomly divided into control group（group C ），dexmedetomidine group （group D ），butorphanol group （group B ），dexmedetomidine+butorphanol group （group E），with 45 cases in each group. Group C received rountine anesthesia of Etomidate emulsion injection+Sufentanil citrate injection+ Cisatracurium besylate for injection. Group D was given Dexmedetomidine injection 0.5 μg/kg by pumping 15 min before induction ， and received rountine anesthesia indution performed in group C. Group B was given intravenous injection of Butorphanol tartrate injection 0.02 mg/kg when anesthesia indution ，and received rountine anesthesia performed in group C. Anesthesia induction in group E was the same as that in group D+B. The dosage of sufentanil and the maintenance concentration of sevoflurane were observed；average arterial pressure （MAP）and heart rate （HR）at the time of entering the room （T0），1 min after intubation （T1）， 1 min after skin incision （T2），and 5 min after extubation （T3），extubation time ，Ramsay sedation score 5 min after extubation and VAS score ，the occurrence of ADR were recorded. RESULTS ：One patient in group C and two patients in Group E were excluded due to the conversion of laparoscopic surgery to open surgery. The rest of the patients completed the study. At T 1-T3，MAP and HR in group C ，D and B were significantly higher than those at T 0（P＜0.05），while there was no significant difference in MAP or HR in group E at T 1-T3，compared with those at T 0（P＞0.05）. MAP of group D and B at T 1-T2 as well as MAP of group E at T 1-T3 were significantly lower than that of group C ，the order was group E ＜group B ＜Group D （except for group B compared with group D at T 3）；HR of group D and E at T 1-T3 as well as that of group B at T 1-T2 were significantly lower than group C ，and the order was group E ＜group B ＜Group D （except for group B compared with group D at T 3）（P＜0.05）. The amount of sufentanil and VAS score of group B ，D，E were significantly lower than that of group C ，and the order was group E ＜group B ＜group D ， VAS score of group E ＜group D ，B（P＜0.05）. The maintenance concentration ，extubation time ，nausea and vomiting ，the incidence of agitation during recovery period in group E were significantly lower or shorter than group C ，D，B. Ramsay sedation score was significantly higer than group C ，D and B. The nausea and vomiting ，the incidence of emergence agitation in group E ＜ group D ，B（P＜0.05）. There was no statistical significance in the maintenance concentration of sevoflurane ，Ramsay sedation score or extubation time among group C ，D and B ，VAS score ，the incidence of nausea and vomiting ，the incidence of agitation during recovery period between group D and B （P＞0.05）. CONCLUSIONS ：Dexmedetomidine combined with butorphanol can effectively reduce the amount of intraoperative anesthetics and the occurrence of stress reaction ，improve the quality of resuscitation，and reduce the incidence of postoperative ADR.
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AIM: To determine the median effective plasma concentration (Cp50) of propofol inhibiting body movement when combined with butorphanol in patients undergoing hysteroscopic surgery. METHODS: Twenty-one patients scheduled for elective hysteroscopic surgery under non-intubated intravenous anesthesia, age 20-55 years old, ASA physical status or Ⅱ, were enrolled in this study, and anesthesia was induced by target-controlled infusion of propofol. Hysteroscopy was performed only when the plasma concentration and the concentration of the effector chamber were balanced. Butorphanol 20 μg/kg was injected intravenously at 5 min before surgery. The depth of anesthesia and adverse reactions during anesthesia was monitored. The plasma target concentration (Cp) of propofol was determined by up-and-down method, the first patient was 2.5 μg/mL, each time Cp increased/decreased by 10% in the next patient depending on whether or not body movement occurred. The patients were divided into positive and negative groups according to the results. The Cp50 and 95% confidence inlerval (CI) of propofol inhibiting body movement were calculated by up-and-down formula when combined with butorphanol in patients undergoing hysteroscopic surgery. RESULTS: The Cp50(95%CI) of propofol required to inhibit body movement was 2.23(2.12-2.34) μg/mL when combined with butorphanol in patients undergoing hysteroscopic surgery. None of the patients had serious adverse reactions. CONCLUSION: The Cp50 of propofol required to inhibit body movement is 2.23 μg/mL when combined with 20 μg/kg butorphanol in patients undergoing hysteroscopic surgery. It provides a reference for safe dosage of anesthesia in hysteroscopic surgery.
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Background: Supraclavicular approach for brachial plexus block offers an alternative anesthesia for upper extremity surgery.Addition of opioid agents in local anesthetic solutions for prolongation of analgesia through brachial plexus block has beenvery effective in controlling post-operative pain. The time to request for the 1st dose of rescue analgesia can be prolonged byadding buprenorphine or butorphanol in local anesthetic solutions.Methodology: After institutional ethical committee approval, 60 American Society of Anesthesiologists I/II patients wererandomized for this study. They belong to either gender, aged between 18 and 55 years of age. Patients who required brachialplexus block through supraclavicular approach were included and the study drugs were administered according to groupallocation into Group I and Group II. Sensory and motor block characteristics were monitored and recorded in all patients,complications as well. Hemodynamic monitoring was done every 5 min interval in the intraoperative period and every 15 minintervals in the post-operative period. Patients were administered rescue analgesia postoperatively when visual analog scale(VAS) scores were ≥4. Data were analyzed statistically.Results: Onset time to sensory block was 3.1 (1.1) min in Group I and 4.9 (1) min in Group II, and there was statistically significantdifference between groups (P < 0.0001). Onset time to motor block was 5.4 (1.3) min in Group I and 9.3 (1.5) min in Group II,and the difference between groups was found to be significant statistically (P < 0.0001). The time to 1st request of analgesiawas found to be statistically significantly between I and II groups (354.8 [55.6] vs. 448.3 [34.4] min, P < 0.0001), respectively.Conclusion: Both buprenorphine and butorphanol produced effective analgesia in combination with local anesthetics withoutsignificant side effects, but buprenorphine produced prolonged analgesia when compared to butorphanol.
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The aim of this study was to investigate the effect of prior administration of butorphanol, lidocaine and normal saline in minimizing Propofol injection pain. Methods: The study comprised of 99 patients divided into three groups of 33 each, in the department operation rooms of Anaesthesiology/Surgery, State Referral Hospital of Zoram Medical College, Falkawn, Mizoram during the period of March 2017 to April 2019. Ninety nine patients of ASA grade I and II, aged between 18 and 60 years of both sexes scheduled to undergo major elective surgery under general anaesthesia were included. Results: Pain on intravenous injection of propofol was experienced by 9 (27.27%) patients from butorphanol group as compared to 18 (54.55%) and 22 (66.67%) patients in the lidocaine and placebo groups respectively. Data analysis showed a chi-square test value of 15.3 and p-value 0f <0.05. Conclusion: The present study shows that prior administration of butorphenol significantly reduced pain on intravenous injection of propofol whereas lidocaine pretreatment too reduces propofol injection pain as compared to a placebo, but failed to show statistically significant results.
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Ropivacaine and levobupivacaine are less cardiovascular and central nervous system toxic, being an alternative to bupivacaine. Butorphanol, an opioid significantly prolongs the duration of the local anaesthetics. Methods: A comparative, Prospective, Randomized, Clinical study was conducted in 60 patients of either sex of ASA I,II ,with age group 18-60 years undergoing upper limb orthopaedic surgeries under USG guided Supraclavicular Brachial Plexus block. Patients were randomly allocated to Group L: 30ml 0.5% Levobupivacaine+600 mcg Butorphanol. Group R: 30ml 0.5% Ropivacaine with 600mcg Butorphanol. Block characteristics were compared as a primary outcome. The data were analyzed with Student-t test. Results: Heart rate, Mean BP, Onset and duration of sensory and motor blockade, Post-op VAS score(every 1 hour for 16hours) were compared intraoperative as well as in the postoperative period. Demographic and hemodynamic data were comparable. All hemodynamic parameters compared were insignificant (P>0.5%).The onset of sensory and motor was significantly earlier in GROUP L (P =0.0048, P=0.002) compared to GROUP R. The duration of sensory and motor block was significantly higher in GROUP L (P=0.00073, P=0.00021). Group R required rescue analgesic earlier than Group L. Conclusion: Though both are long acting and safer than bupivacaine, Levobupivacaine is better than ropivacaine in terms of early onset of sensory-motor blockade and prolonged duration of sensory-motor blockade. Butorphanol augments the efficacy of local anesthetics without any untoward side effects.
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The goal of present study is to compare intraoperative and postoperative hemodynamic and sensory/ motor effects of low dose intrathecal butorphanol with bupivacaine versus high dose intrathecal butorphanol with bupivacaine in patients undergoing elective lower limb surgeries. Methods: This randomized, double blind comparative study was conducted in 60 patients belonging to ASA grade I or II, aged 20-60 years admitted for lower limb surgeries under spinal anesthesia. The patients were randomly divided into 2 groups. (A and B, n=30 for each group). Group A received combination of 0.5% hyperbaric bupivacaine (2.5 ml) with low dose butorphanol (25 microgram in 0.5 ml) intrathecally and group B received combination of 0.5% hyperbaric bupivacaine (2.5 ml) and high dose butorphanol (50 microgram in 0.5 ml) intrathecally. Preoperative and intraoperative vitals; side effects; intensity of motor blockade, time of onset of sensory and motor blockade; time taken for peak sensory and motor blockade; time for two segment sensory regression and time for rescue analgesia were compared in both group. Results: Time taken for peak sensory block was significantly lesser in group B and time for two-segment regression of sensory level and time to rescue analgesia were also significantly higher in group B, in which high dose intrathecal butorphanol-bupivacaine mixture was used. There was no difference in time taken to onset of sensory block, time taken to onset of motor block, time taken for peak motor block and in the intensity of motor blockade in using high dose intrathecal butorphanol-bupivacaine mixture as compared to low dose intrathecal butorphanolbupivacaine mixture. Conclusion: We concluded that high dose intrathecal butorphanol (50 μgm) with bupivacaine is well tolerated and potentiates the sensory block better than low dose intrathecal butorphanol (25 μgm) with bupivacaine with out any major side effects. It did not increase postoperative motor block recovery time and has delayed the postoperative analgesic requirement.
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Intrathecal opioids when added to local anaesthetics decrease their dosage and provide haemodynamic stability. Subarachnoid block is a common anesthesia procedure for lower abdominal or lower limb surgeries including perineal surgeries. Objectives: To assess the efficacy of anesthesia and analgesia between intrathecal fentanyl and butorphanol with bupivacaine heavy 0.5% for lower limb orthopaedic surgery. Methods: About 120 patients, aged 18-75 years, belonging to American society of anesthesiologists (ASA) physical status 1 or 2 and scheduled for elective, lower limb orthopedic surgeries was randomized into two groups. Group A received 2.5ml of 0.5% hyperbaric bupivacaine with 0.5ml (25μg fentanyl) a total volume of 3ml intrathecally. The Butorphanol was diluted using distilled sterile water to obtain 25μg in 0.5ml. This was then added to 2.5ml of 0.5% hyperbaric bupivacaine to make a total volume of 3ml which was given to group B. Results: The times required for onset of sensory and motor blockade were comparable among the two groups. Significantly slower block regression to S2 level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl (P<.001). A higher number of patients in group A requested for rescue analgesia during the postoperative period than in group B (11 versus 3; P=0.0326). The average times to first request for rescue analgesia were 254.47±9.31 minutes and 291±8.45 minutes in group A and B, respectively (P<0.001). Conclusion: Both 25μg fentanyl and 25μg butorphanol given intrathecally along with 12.5 mg of hyperbaric bupivacaine provide effective anesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture.
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Objective To investigate the effect of Dexmedetomidine hydrochloride combined with Butorphanol tartrate on stress state in elderly patients with severe illness.Methods A total of 120 elderly patients with severe illness admitted into our hospital from March 2016 to March 2018 were randomized into group A,B and C(n=40,each).Group A was given intravenous Midazolam for analgesia,group B was treated with intravenous Medetomidine for analgesia,and group C received Dexmedetomidine combined with Butorphanol tartrate for analgesia.The differences in mean artery pressure(MAP),heart rate(HR),C-reaction protein(CRP),interleukin-6 (IL-6),visual analogue scale (VAS)score and Ramsay score were compared among the three groups.Results The levels of MAP,HR,CRP,IL-6 and VAS score after 24,48 and 72 hours of combined treatment of dexmedetomidine and butorphanol tartrate were lower in group C than in group B(P ＜0.05).There was no significant difference in the levels of MAP,HR,CRP,IL-6 and VAS score between group A and B after 24,48 and 72 hours of administration(P＞0.05).Ramsay score was higher in group C (intravenous both Dexmedetomidine and Butorphanol tartrate) than in group B (intravenous Dexmedetomidine alone)at 24,48 and 72 hours after administration (P ＜ 0.05).There was no significant difference in Ramsay score after 24,48 and 72 hours of administration between group A and B(P＞0.05).The incidence of adverse reactions was lower in group C than in group A and B(10.0％ vs.35.0％ and 32.5％,x2 =7.168 and 6.050,P =0.007 and 0.014).There was no significant difference in the incidence of adverse reactions between group A and BCx2=0.056,P =0.813).Conclusions Dexmedetomidine hydrochloride combined with Butorphanol tartrate can effectively improve hemodynamics,and alleviate inflammatory reaction and pain in elderly patients with severe illness,with a good security.And it is worthy of clinical generalization.
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Objective To observe the effect of patient controlled intravenous analgesia(PCIA)of remifentanil combined with butorphanol in high-intensity focused ultrasound(HIFU)treatment of uterine fibroids or adenomyosis. Methods A total of 56 patients with uterine fibroids or adenomyosis treated with HIFU were selected.At 15 min before the treatment,1 mg of butorphanol was intravenously injected,and then a PCIA pump was connected.The PCIA solution was butorphanol 2 mg and remifentanil 2 mg diluted to 100 ml.The initial dose was 1 μg/kg,the basal rate was 6 μg· kg-1· h-1,the bolus was 1 μg/kg,and the lock out time was 1 min.The respiratory rate,heart rate,mean arterial pressure(MAP),oxygen saturation(SpO2), VAS scores,and Ramsay sedation scores were recorded at each time points,which were T1(at the beginning of surgery),T2(the vital signs were recorded every 30 min during the surgery,the mean values of the data were taken as T 2 values),T3(the end of surgery),and T4(30 min after the end of surgery).Additional medications and complications,such as dizziness,nausea,vomiting,respiratory depression were recorded,too. Results The operations were accomplished in all the 56 cases.The operation time was(97.8 ±44.7)min.As compared to the T1 time point,the MAP and SpO2during and after treatment at each time points had no significant differences(F=1.398, P=0.245;F=1.819, P =0.155).The respiratory frequency and heart rate during treatment significantly decreased as compared to before treatment(F=109.020,P=0.000;F=115.023,P=0.000).At 30 min after treatment,the respiratory frequency rose but had no significant difference as compared to the baseline(P=1.000).The heart rate also speeded up but still below the level at the beginning of the treatment,with the difference having statistical significance(P=0.002).Analgesia effective rate was 94.6%(53/56).The Ramsey scores were(2.4 ±0.5)points during the treatment,(2.2 ±0.5)points at the end of the treatment,and(2.0 ±0.2)points at 30 min after treatment.The sedation effect was satisfactory. Conclusion PCIA of butorphanol combined with remifentanil is effective and safe for HIFU in the treatment of uterine myoma or adenomyosis.
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Objective To compare the effect of dexmedetomidine combined with butorphanol to prevent the adverse effects of carboprost tromethamine druing cesarean delivery.Methods Ninety parturients with the risk factor of uterine atony,aged 24-40 years,weighting 55-85 kg,ASA physical status Ⅰ or Ⅱ,undergoing full term cesarean section,were randomly divided into dexmedetomidine combined with butorphanol group (group DB,n=30),butorphanol group (group B,n=30)and control group (group N,n=30).Three groups were intravenously injected corresponding drugs of carboprost tromethamine into uterus.Group DB was given intravenous injection dexmedetomidine 1 μg/kg combined with butorphanol 20 mg/kg.Group B was given butorphanol 20 mg/kg.Group N was given 0.9% sodium chloride solution.MAP,HR,and SpO2were recorded at different times,10 min after go into operation room (T0),10 min after carboprost tromethamine into uterus (T1),end of operation (T2).Ramsay sedation score was recorded at T1.The adverse effects of carboprost tromethamine were recorded.The initial time of lactation after operation was recorded.The initial time of lactation after operation,the height of uterine fundus at 1,3,5 d after operation,the oxyto-cin doses within 72 h after operation were recorded.Results Compared with group N,the MAP and HR of group DB and group B decreased obviously at T1(P<0.05),and group DB was lower than group B obviously at T1(P<0.05).Compared with group N,the scores of Ramsay in group DB and group B were significantly higher (P<0.05),group DB was higher than that of group B(P<0.05). Compared with group N,the incidence of nausea,vomiting,chest tightness,chest pain,hyperten-sion,tachycardia and chills in group B and group DB were significantly lower (P<0.05),and group DB was lower than that of group B (P<0.05).There were no significant differences of the initial time of lactation after operation,height of uterine fundus at 1,3,5 d after operation,the oxytoxin doses within 72 h after operation between the three groups.Conclusion Dexmedetomidine combined with butorphanol can effectively reduce the adverse effects of carboprost tromethamine druing cesarean delivery,the more stable hemodynamics and sedative effect,the effect is better than the sin-gle application of butorphanol,at the same time does not affect lactation,it is safe and effective for clinical use.
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Objective To investigate the effects of dexmedetomidine combined with butorphanol on postoperative an-algesia and recovery for patient-controlled intravenous analgesia (PCIA) in parturients undergoing cesarean section. Methods Eighty-four parturients scheduled for elective caesarean section under spinal anaesthesia were randomly al-located into two groups. Control group: physiological saline infusion(0.5 μg/kg) after delivery and butorphanol (10 mg) in PCIA. Experimental group: dexmedetomidine (0.5 μg/kg) infusion after delivery and dexmedeto-midine (200 μg) with butorphanol (10 mg) in PCIA. Hemodynamic variables, the visual analogue score (VAS), the sedation score, side effects, the total pump-press number and additional analgesics cases were re-corded. The quality of recovery was evaluated by using a 40-item quality of recovery questionnaire(QoR-40) and a 9 questions fatigue score(FFS). Results Compared with control group,the VAS scores,the total pump-press number, the incidence of side effects and the FSS scores in experimental group was significantly decreased (P<0.05). In addition,the QoR-40 score at POD3 was significantly increased(P<0.05). Conclusions Dexmedeto-midine combined with butorphanol for PCIA after caesarean section decreases the consumption of butorphanol,pro-motes postoperative analgesia,alleviates fatigue,and improves postoperative recovery.
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Pain is a common and crucial problem in clinical practice, because it has a profound influence on patients in perioperative period. Butorphanol, among plenty of analgesics, is widely used in clinical trials for its various advantages and better analgesic effects. As a typical agonist-antagonist opioid analgesic agent, butorphanol, however, shows different clinical manifestations with different affinity for opioid receptors 25∶4∶1 (κ∶μ∶δ). Besides, butorphanol provides remarkable analgesic and sedative effect in preemptive analgesia, induction and recovery period in general anesthesia, and postoperative analgesia And it could be as a adjuvant to local anaesthesia either. Compared with other opioid drugs, butorphanol is less likely to have side effect on respiratory depression. In addition, its physical dependence is extremely low.
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Objective To compare the analgesic effect and adverse event of butorphanol and dezocine which are combined with sufentanil and flurbiprofen axetil in PCIA,to screen out a relatively good analgesic.Methods 110 laparotomy cases from hepato-pancreato-biliary (HPB) department and 160 laparoscopy cases from general surgery(GS) department of xinqiao hospital of third medical university were included in our study.All patients were randomly divided into two groups according to the random number table method,namely the butorphanol group and dezocine group.Butorphanol 0.04 mg/kg,sufentanil 2.8 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg were used in HPB butorphanol group.Dezocine 0.2 mg/kg,sufentanil 2.8 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg were used in HPB dezocine group.Butorphanol 0.04 mg/kg sufentanil 2.5 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg was used in GS butorphanol group.Dezocine 0.2 mg/kg,sufentanil 2.5 μg/kg,flurbiprofen axetil 3 mg/kg and granisetron 6 mg was used in GS dezocine group.The mean arterial pressure(MAP),heart rate(HR),facial expressions of pain score,sedation score,PONV score,NRS score and respiratory depression were observed in postoperative 0 hour,6 hours,24 hours,48 hours.Results For both two departments,the numbers of patients with NRS score and facial expressions of pain scores greater than 3 in dezocine group were more than those in butorphanol group,the differences were significant(P ＜ 0.05).There was no statistically significant difference in numbers of patients with NRS score and facial expressions scale of 1 to 3 (P ＞ 0.05).while the number of cases with sedation score ranged from 1 to 3 in dezocine group was less than that in both HPB and GS butorphanol group(P ＜ 0.05).There was no statistically significant difference in PONV score and itching score which was or less than 3 or more than 3 (P ＞ 0.05).Conclusion For postoperative analgesia in PCIA,butorphanol has better analgesic effect than the same dose of dezocine,and stronger sedation effect than dezocine.