Effects Of Transnasal Butorphanol On Postoperative Pain

ObjectiveThe present study was designed to evaluate the efficacy and tolerability of transnasalbutorphanol in the treatment of postoperative pain.MethodsForty ASAⅠ～Ⅱpatients scheduled for modified radical mastectomy under generalanesthesia were enrolled and randomized into two groups: Butorphanol (â… ) group (n=20)and control (â…¡) group (n=20). When patients reported experiencing moderate or severepostoperative pain (VAS≥4), they received a puff of transnasal butorphanol (1 mg/puff) orsaline.If satisfactory analgesia was not obtained, a second puff was given 60 minutesafterwards. The patients recieved rescue medication 1 hour after twice nasal sprays did notproduce satisfactory analgesia. The same remediation was given every 4 hours ifnecessary. Pain intensity (PI), pain intensity difference (PID) and pain relief (PAR) weremeasured before dosing and 0.5,1,2,4,6,20,24 h after the initial dose. Sum of painintensity difference (SPID) and total pain relief (TOTPAR) were calculated. Consumptionof transnasal drug and rescue medication were recorded. Vital signs (heart rate, bloodpressure, respiratory rate, SpO₂), Remesay sedation score (RSS), postoperative nauseaand vomiting (PONV) and other adverse events were monitored during analgesia. Patientswere asked to provide a global assessment of transnasal drug at the end of the study.ResultsBoth SPID (13.4±3.7) and TOTPAR (10.3±2.9)in groupâ…¡were significantly lower thanthose in groupâ… (SPID: 21.1±5.9, TOTPAR: 15±4.6, P＜0.05). The consumption oftransnasal drug and rescue medication during analgesic therapy (P＜0.05) in groupâ… weresignificantly less than that in control group. Compared with that in groupâ…¡, the analgesiceffect was superior in groupâ… .The vital signs including blood pressure, heart rate,respiratory rate were significantly decreased after the initial dose in groupâ… , but they werewithin safe range.These vital signs were significantly higher at 0.5, 1,2 h after the initialdose in groupâ…¡than those in groupâ… . Compared with that in groupâ… , blood pressure wassignificantly lower 4 h after the initial dose in groupâ…¡. After the initial dose treatment, there were four patients whose RSS was 3 and one patient whose RSS was 4 in groupâ… .During analgesic therapy, there were two patients suffered from nausea in groupâ… . RSSwas between 1 and 2 in groupâ…¡before taking rescue medication, but increased to 3 in 8patients, 4 in ten patients and 5 in two patients after taking rescue medication. There werefour patients suffered from nausea in groupll during analgesic therapy.ConclusionsTransnasal butorphanol produced a fast onset, high efficient and well pain control actionwith mild adverse effect, which can provide effective postsurgical analgesia for modifiedradical mastectomy.