The Efficacy of Low-Dose Ketamine Added to Postoperative Patient-Controlled Analgesia / 대한마취과학회지

BACKGROUND: Low-dose ketamine (0.25 - 0.5 mg/kg) has been shown to provide adequate analgesia for postoperative pain treatment. Ketamine at a subanesthetic dose blocks the delta-channel associated with the N-methyl-D-aspartate (NMDA) receptor, and this mechanism may underlie its analgesic effects. The aim of the present study was to dertermine if low-dose ketamine in addition to postoperative patient-controlled analgesia (PCA) potentiates the analgesic effect of opioids. METHODS: Sixty patients scheduled for total abdominal hysterectomy were divided into three groups. After awakening patients from general anesthesia, they received butorphanol 10 mg, ketorolac 240 mg and ondansteron 4 mg with normal saline 2 ml (control group) or ketamine 50 mg and normal saline 1 ml (ketamine 50 group) or ketamine 100 mg (ketamine 100 group) by PCA pump (1 ml of demand dose, 10 min lock-out interval and 100 ml total volume). The severity of pain, nausea, vomiting and sedation were assessed at 0, 1, 2, 6, 12, 24, 36 and 48 h after awakening. RESULTS: The total amount of butorphanol and ketorolac consumption was higher in the control group (8.6 mg, 206 mg) than in the ketamine 50 (6.2 mg, 148 mg) and ketamine 100 groups (5.3 mg, 127.2 mg). Ketamine consumption was higher in the ketamine 100 group (53.1 mg) than in the ketamine 50 group (31.7 mg). There was no difference among the groups in pain score, but the incidence of nausea and vomiting was higher in control group (40%) than in the other groups (10% each). Sedation scores were higher in the ketamine 100 group than in the other groups (P < 0.05). CONCLUSIONS: The addition of 50, 100 mg of ketamine decreases PCA drug consumption and incidence of nausea and vomiting (26 39%).

The Effect of Butorphanol on Propofol-N2O-O2 Anesthesia: Propofol Dose Requirements, Hemodynamic Responses, and Postoperative Recovery Profiles / 대한마취과학회지

BACKGROUND: This study was proposed to examine the effects of butorphanol on propofol dose requirements and hemodynamic responses during propofol-N2O-O2 anesthesia. In addition, the effects of butorphanol on the recovery time, sedation score and postoperative first analgesic request time were assessed. METHODS: Forty patients were allocated to 2 groups. Twenty patients received butorphanol (20 microgram/kg, group (B) and the others received an equal volume of placebo (group P) 3 minutes before induction with propofol. After induction, anesthesia was maintained with propofol (6 - 10 mg/kg, iv)-N2O (70%)-O2 (30%). Propofol doses for induction and maintenance and hemodynamic responses (blood pressure, heart rate) were checked. After surgery, sedation score, recovery profiles, and postoperative first analgesic request time were assessed. RESULTS: The induction doses of propofol were lower in group B than in group P. Diastolic pressure and heart rate decreased in group B compared to group P after endotracheal intubation and before skin incision. After skin incision, decreased diastolic pressure and heart rate returned to preanesthetic levels in group P, but the decreased level was sustained in group B. There were group differences in sedation score at 5 and 10 minutes after extubation. In group B, recovery was delayed and more time elapsed before the first analgesic request. CONCLUSIONS: Butorphanol co-administered with propofol reduces the induction dose of propofol and delays the first analgesic request time, but there are significant fluctuations in blood pressure and heart rate during endotracheal intubation and skin incision.

Comparison of the Effects of Morphine Versus Morphine Plus Butorphanol in Epidural Anesthesia for Postoperative Analgesia / 대한마취과학회지

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as nausea, vomiting, respiratory depression, and pruritus. The purpose of this study was to evaluate the analgesic efficacy and side effects by combination use of epidural morphine and butorphanol. METHODS: Forty five patients were randomly divided into 3 groups. For group I, a bolus of 4.7 ml of saline and 3 mg of morphine were administered. For group II, a bolus of 4.2 ml of saline and 3 mg of morphine and 1 mg of butorphanol were administered. For group III, a bolus of 3.2 ml of saline and 3 mg of morphine and 3 mg of butorphanol were administered. Continuous epidural analgesia were administered for all groups; group I (saline 99.4 ml and morphine 6 mg), group II (saline 98.4 ml, morphine 6 mg, and butorphanol 2 mg), group III (saline 96.4 ml, morphine 6 mg, and butorphanol 6 mg) by two day infuser, 2 ml/hr. We compared the side effects and analgesic effect of the three groups for 2 days. RESULTS: The incidence of pruritus, nausea and vomiting was reduced significantly in the group II and III, but the incidence of somnolence increased in the group III. There were no significant differences in analgesic effect and the other side effects among the three groups. CONCLUSION: Above results suggest that the addition of butorphanol to morphine in epidural infusion reduce the incidence of pruritus, nausea and vomiting, but increase the incidence of somnolence.

Comparison of the Effects of Morphine Versus Morphine Plus Butorphanol in Epidural Anesthesia for Postoperative Analgesia / 대한마취과학회지

BACKGROUND: Epidural morphine has been commonly used to provide postoperative pain relief, but it has many side effects such as nausea, vomiting, respiratory depression, and pruritus. The purpose of this study was to evaluate the analgesic efficacy and side effects by combination use of epidural morphine and butorphanol. METHODS: Forty five patients were randomly divided into 3 groups. For group I, a bolus of 4.7 ml of saline and 3 mg of morphine were administered. For group II, a bolus of 4.2 ml of saline and 3 mg of morphine and 1 mg of butorphanol were administered. For group III, a bolus of 3.2 ml of saline and 3 mg of morphine and 3 mg of butorphanol were administered. Continuous epidural analgesia were administered for all groups; group I (saline 99.4 ml and morphine 6 mg), group II (saline 98.4 ml, morphine 6 mg, and butorphanol 2 mg), group III (saline 96.4 ml, morphine 6 mg, and butorphanol 6 mg) by two day infuser, 2 ml/hr. We compared the side effects and analgesic effect of the three groups for 2 days. RESULTS: The incidence of pruritus, nausea and vomiting was reduced significantly in the group II and III, but the incidence of somnolence increased in the group III. There were no significant differences in analgesic effect and the other side effects among the three groups. CONCLUSION: Above results suggest that the addition of butorphanol to morphine in epidural infusion reduce the incidence of pruritus, nausea and vomiting, but increase the incidence of somnolence.

Comparison of Butorphanol and Fentanyl Administered with Bupivacaine for Patient Controlled Epidural Analgesia after Cesarean Section / 대한마취과학회지

BACKGROUND: For the efficacy of pain relief, the adequate infusion dosage and the side effects of epidural butorphanol was compared with those of epidural fentanyl. METHODS: Forty consenting, healthy, term parturients who had undergone Caesarean section under epidural lidocaine anesthesia received 0.1% bupivacaine/ butorphanol 50 ug/ml (Group 1, n=20) or 0.1% bupivacaine/fentanyl 5 ug/ml (Group 2, n=20) using patient controlled epidural analgesia (PCEA) were evaluated. RESULTS: Total amount of 48hr consumption was 19.4 mg (butorphanol) and 1546.8 ug (fentanyl). There were no significant differences between two groups in total infusion doses of above drugs, VAS score and side effects. The putative potency ratio of fentanyl/butorphanol was 1/12.5. CONCLUSIONS: Although both butorphanol and fentanyl were useful and safe drug for PCEA for postoperative pain control, combination of butorphanol and bupivacaine provided more economically effective analgesia.

Epidural Butorphanol Reduces the Side Effects from Epidural Morphine after Cesarean Section / 대한마취과학회지

BACKGROUND: Epidural morphine has side effects, especially pruritus, nausea, and vomiting. Butorphanol has been added in studies to reduce these side effects in post cesarean patients. The purpose of this study was to evaluate the side effects and analgesic efficacy when a combination of epidural morphine and butorphanol was administered in patients having combined local anesthetic and opioid epidural infusion. METHODS: Sixty patients having epidural anesthesia for cesarean section were randomly divided into two groups. Group M (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and saline 0.75 ml, whereas group B (n=30) received a bolus of 0.25% bupivacaine 4 ml, morphine 2 mg, and butorphanol 1.5 mg (0.75 ml). Continuous epidural infusion was done by Two-day Infusor containing either 0.25% bupivacaine 75 ml, morphine 5 mg, and saline 20 ml in group M or 0.25% bupivacaine 75 ml, morphine 5 mg, butorphanol 4 mg (2 ml), and saline 18 ml in group B. We compared the side effect and analgesic effect of group M to those of group B for 2 days. RESULTS: The incidence of pruritus and vomiting were reduced significantly in group B (p<0.05). There were no significant differences between both groups in the incidence of nausea or other side effects as well as no differences in analgesic effect. CONCLUSIONS: We conclude that the addition of butorphanol to morphine in combined local anesthetic and opioid epidural infusion for postoperative analgesia decreases the occurrence of pruritus and vomiting without significant increase of other side effects and adverse effect on analgesia.

Comparison of Butorphanol and Morphine Patient Controlled Analgesia after Gynecological Surgery / 대한마취과학회지

BACKGROUND: Intravenous patient controlled analgesia (IV-PCA) is a very popular and relatively safe technique due to its innate negative feedback mechanism. Morphine, the most commonly used analgesic, however, has its own drawbacks due to troublesome side effects. Narcotic agonist-antagonists are known to have ceiling effects not only to their analgesic potency, but also to their side effects. The authors studied the efficacy and incidence of side effects of Butorphanol IV-PCA for postoperative analgesia and compared these to morphine. METHODS: 38 ASA class I or II patients, undergoing gynecological surgery were randomly assigned into two groups, respectively Butorphanol and Morphine and examined hemodynamic changes, overall pain relief, patients satisfaction and the frequency of side effects. After general anesthesia, each patient randomly received loading dose of butorphanol or morphine in the recovery room and discharged to the floor with the PCA module. Upon arrival, individual patient was evaluated at predetermined time interval for 24 hours. RESULTS: The percentage of patient satisfaction was very high in both groups. The incidence of nausea was less in butorphanol group. The incidence of other side effects was statistically insignificant. CONCLUSIONS: Butorphanol has less incidence of side effects and comparable level of analgesia when compared to morphine. We conclude that butorphanol may be considered as a part of routine IV-PCA regimen, in postoperative pain management.