Effect of butorphanol tartrate combined with dexmedetomidine on postoperative analgesia

Xiaofeng  Xu; Linsen  Zhan; Huarong  Lu; Gongmin  Yu; Changxing  Xia; Yongqing  Xu; Gang  Liu; Yuhui  Chai; Yunping Lan

doi:10.2298/VSP230606003X

Xiaofeng Xu The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China
Linsen Zhan The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China
Huarong Lu Jiangshan People’s Hospital of Zhejiang Province, Jiangshan, Zhejiang Province, China
Gongmin Yu The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China
Changxing Xia The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China
Yongqing Xu People’s Hospital of Changshan, Changshan, Zhejiang Province, China
Gang Liu The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China
Yuhui Chai The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China
Yunping Lan The Quzhou Affiliated Hospital of Wenzhou Medical University, Quzhou People’s Hospital, Department of Anesthesiology, Quzhou, Zhejiang Province, China

DOI: https://doi.org/10.2298/VSP230606003X

Keywords: analgesia, patient-controlled;, anesthesia, general;, dexmedetomidine;, drug-related side effects and adverse reactions;, pain, postoperative

Abstract

Background/Aim. Since finding a safe and efficient strategy of multimodal postoperative analgesia and sedation is particularly critical, it is important that dexmedetomidine (DM) combined with opioid anesthetics can enhance that through a synergistic action. The aim of the study was to assess the effect of butorphanol tartrate (BT) combined with DM on postoperative analgesia. Methods. A total of 100 elderly patients undergoing general anesthesia surgery from January 2019 to June 2022 were selected. The patients were divided into two equal groups – research group (RG) and control group (CG), using the random number table method. All patients were given postoperative patient-controlled intravenous analgesia (PCIA) plus background infusion. CG patients were given 10 mg of BT, and RG patients were given 10 mg of BT and 300 μg of DM. The analgesics were diluted in 100 mL of 0.9% normal saline. The doses of rescue analgesic tramadol within 48 hrs after surgery, the number of PCIA boluses 48 hrs after surgery, and postoperative hospitalization time were recorded. The Visual Analog Scale (VAS) score, Ramsay sedation score (RSS), inflammatory and stress responses [interleukin (IL)-6, interferon (IFN)-γ, and angiotensin II (Ang-II)], and anesthesia-related adverse reactions (ARAR) were compared at different time points. Results. The dose of tramadol within 48 hrs after surgery, the number of PCIA boluses 48 hrs after surgery, and the postoperative hospitalization time of RG were lower than those of CG (p < 0.05). VAS scores at rest and during activity and serum IL-6, IFN-γ, and Ang-II levels of both groups increased at 4 and 12 hrs after surgery, then decreased at 24 hrs after surgery. The above indicators of RG were lower than those of CG at each time point (p < 0.05). The RSSs of the two groups increased at 4, 12, and 24 hrs after surgery, then dropped at 48 hrs after surgery. The scores of RG were lower than those of CG at each time point (p < 0.05). The incidence rates of ARAR had no significant difference between RG and CG (p > 0.05). Conclusion. BT combined with DM is effective for analgesia and sedation after general anesthesia surgery in elderly patients, which can reduce inflammatory and stress responses without increasing ARAR.

References

Salicath JH, Yeoh EC, Bennett MH. Epidural analgesia versus patient-controlled intravenous analgesia for pain following in-tra-abdominal surgery in adults. Cochrane Database Syst Rev 2018; 8(8): CD010434.

Klotz R, Larmann J, Klose C, Bruckner T, Benner L, Doerr-Harim C, et al. Gastrointestinal Complications After Pancreatoduo-denectomy With Epidural vs Patient-Controlled Intravenous Analgesia: A Randomized Clinical Trial. JAMA Surg 2020; 155(7): e200794.

Dinges HC, Otto S, Stay DK, Bäumlein S, Waldmann S, Kranke P, et al. Side Effect Rates of Opioids in Equianalgesic Doses via Intravenous Patient-Controlled Analgesia: A Systematic Re-view and Network Meta-analysis. Anesth Analg 2019; 129(4): 1153–62.

Zhu RY, Xiang SQ, Chen DR. Combined lumbar muscle block and perioperative comprehensive patient-controlled intrave-nous analgesia with butorphanol in gynecological endoscopic surgery. World J Clin Cases 2021; 9(34): 10540–8.

Kaye AD, Chernobylsky DJ, Thakur P, Siddaiah H, Kaye RJ, Eng LK, et al. Dexmedetomidine in Enhanced Recovery After Surgery (ERAS) Protocols for Postoperative Pain. Curr Pain Headache Rep 2020; 24(5): 21.

Ding X, Luo Y, Shi L, Liu C, Yan Z. Butorphanol in combina-tion with dexmedetomidine provides efficient pain manage-ment in adult burn patients. Burns 2021; 47(7): 1594–601.

Zhang XH, Liu S, Liao WM. Combination of Dexmedetomi-dine and Butorphanol Optimized Sedation in Drug-Induced Sleep Endoscopy: A Randomized, Double-Blind Trial. Curr Med Sci 2021; 41(6): 1247–51.

Yi-Han W, Rong T, Jun L, Min W, Yan Z, Yi L, et al. Dexme-detomidine combined with ropivacaine for erector spinae plane block after posterior lumbar spine surgery: a randomized controlled trial. BMC Musculoskelet Disord 2022; 23(1): 235.

Jin XB, Xiao R, Zhou W, Liu C, Luo YR, Liu RH, et al. Effect of Different Modes of Administration of Dexmedetomidine Combined with Nerve Block on Postoperative Analgesia in Total Knee Arthroplasty. Pain Ther 2021; 10(2): 1649–62.

Saidie S, Modir H, Yazdi B, Moshiri E, Noori G, Mohammadbeigi A. The effect of dexmedetomidine on decrease of cough, he-modynamic parameters and Ramsay score versus lidocaine during general anesthesia: a randomized clinical trial. Med Gas Res 2021; 11(1): 1–5.

Fujiyama M, Jones T, Duke-Novakovski T. Evaluation of the perioperative stress response from dexmedetomidine infusion alone, with butorphanol bolus or remifentanil infusion com-pared with ketamine and morphine infusions in isoflurane-anesthetized horses. Vet Anaesth Analg 2021; 48(3): 344–55.

Chen S, Xu Z, Liu H, Zhang Y, Zhang J, Chen Y, et al. Perioper-ative patient-controlled regional analgesia versus patient-controlled intravenous analgesia for patients with critical limb ischaemia: a study protocol for a randomised controlled trial. BMJ Open 2020; 10(10): e037879.

Liu S, Peng P, Hu Y, Liu C, Cao X, Yang C, et al. The Effec-tiveness and Safety of Intravenous Dexmedetomidine of Dif-ferent Concentrations Combined with Butorphanol for Post-Caesarean Section Analgesia: A Randomized Controlled Trial. Drug Des Devel Ther 2021; 15: 689–98.

Xu G, Zhao J, Liu Z, Liu G, Liu L, Ren C, et al. Dexme-detomidine Combined With Butorphanol or Sufentanil for the Prevention of Post-operative Nausea and Vomiting in Pa-tients Undergoing Microvascular Decompression: A Random-ized Controlled Trial. Front Med (Lausanne) 2020; 7: 583031.

Ahsan MZ, Khan FU, Zhao MJ, Wang YX. Synergistic interac-tion between butorphanol and dexmedetomidine in antino-ciception. Eur J Pharm Sci 2020; 149: 105322.

Du J, Li JW, Jin J, Shi CX, Ma JH. Intraoperative and postop-erative infusion of dexmedetomidine combined with intrave-nous butorphanol patient-controlled analgesia following total hysterectomy under laparoscopy. Exp Ther Med 2018; 16(5): 4063–9.

Shi XX, Gan GF. Safety and effectiveness of dexmedetomi-dine combined with butorphanol in patient-controlled intra-venous analgesia in elderly patients treated with proximal femoral nail anti-rotation. J Int Transl Med 2017; 5(4): 212–6.

Kreisler RE, Cornell HN, Smith VA, Kelsey SE, Hofmeister EH. Use of nalbuphine as a substitute for butorphanol in combina-tion with dexmedetomidine and tiletamine/zolazepam: a ran-domized non-inferiority trial. J Feline Med Surg 2020; 22(2): 100–7.

Rydén A, Jensen-Waern M, Nyman G, Olsén L. Physiological and Clinical Responses in Pigs in Relation to Plasma Concentra-tions during Anesthesia with Dexmedetomidine, Tiletamine, Zolazepam, and Butorphanol. Animals (Basel) 2021; 11(6): 1482. Erratum in: Animals (Basel) 2021; 11(12): 3474.

Liu H, Wang Y, Li F, Ren W, Yuan L. Analgesic and Sedative Effects of Different Doses of Dexmedetomidine Combined with Butorphanol in Continuous Analgesia after a Cesarean Section. Front Surg 2022; 9: 896536.

Wang X, Wang Z, Sun C, Cui Z. Clinical Study of Dexme-detomidine in Combination with Butorphanol for the Treat-ment of Postoperative Traumatic Brain Injury (TBI). Turk Neurosurg 2022; 1–6.

Wang L, Zhang T, Huang L, Peng W. Comparison between Dexmedetomidine and Midazolam for Sedation in Patients with Intubation after Oral and Maxillofacial Surgery. Biomed Res Int 2020; 2020: 7082597.

Ding X, Cui H, Ma P, Chen X, Sun Y, Qu M, et al. Efficacy of dexmedetomidine versus midazolam when combined with bu-torphanol for sedation and analgesia during burn dressing changes: A randomized clinical trial. Front Pharmacol 2022; 13: 965441.