The Evaluation Of Butorphanol Tartrate Nasal Spray Used For Postoperative Analgesia After Laparoscopic Cholecystectomy

Objective:To evaluate the effect, economical efficiency and safety about using butorphanol tartrate nasal spray for postoperative analgesia after laparoscopic cholecystectomy.Methods:120 patients undergoing elective laparoscopic cholecystectomy were randomly divided into four groups, one using butorphanol tartrate nasal spray(BT) and three controlled groups using PCIA, which included butorphanol tartrate(NB), tramadol(NT) and normal saline as placebo(NP). Each group included 30 patients. We recorded patient's oxyhemoglobin saturation(SPO2), breathing rate (RR), heart rate(HR), and mean arterial pressure (MAP), at the time when surgery finished and at the time 1 hour,4 hours,8 hours,12 hours,24 hours, and 48 hours after surgery. At the same time we evaluated Ramsay sedation and visual analgesia score (VAS). When VAS pain score beyond 7, the following was suggested:we can give 3 mg morphine in vein if the patient agreed; we recorded vital signs and adverse reactions in the whole course; we surveyed the satisfactory degree after the course finished while we counted the number of pressing the PCA in the next 48 hours; and at last the data were analyzed by using the benefit and cost analyses based on pharmaco-economics assay. Results:We found, during the examined hours, VAS pain score of Group BT was lower than Group NP(P<0.05), the number of using rescue drugs after surgery(2/30) is obviously lower than Group NP (8/30) (P<0.05), and the number of effective analgesia (NB 9/30, vs BT 1/30) and the numbers of fundamental valid analgesia(NB 25/30, vs BT 4/30) were significantly different (P<0.05). At the time of 1 hour,4 hours,and 8 hours after surgery, the VAS in Group BT was higher than Group NB or Group NT (P<0.05); At the time of 12 hours,24 hours,48 hours after surgery (P>0.05), the pain score in Group BT and Group NB or Group NT were not significantly different, and the numbers in effective analgesia in Group BT (9/30) were significantly different with those in Group NB (18/30) and Group NT (15/30) (P<0.05); However, there was no significant difference (P>0.05) in the fundamental validity(NB25/30,NT29/30,NP28/30) and times to use rescue drugs (NB2/30, NT 0/30, NP 0/30) among these three groups. The number of pressing the PCA in the next 48 hours in using Group BT and in using Group NB or Group NT was not significantly different (P>0.05), while compared with Group NP it was significantly different (P<0.05).The vital signs of four groups after surgery have no difference.The adverse reactions incidence rate between the four groups were low, and the reactions among them were not significantly different. When we defined the success to analgesia as the basic line, Group BT's cost/benefit ratio was obviously better than Group NB's and Group NT's, which means better economic influence.Conclusions:When undergoing electived laparoscopic cholecystectomy patients, using butorphanol tartrate nasal spray can work, causing less adverse reactions and producing more economic benefits. It is a good choice for the patients undergoing the small or moderate surgery.