A Comparison Of Butorphanol Premedication By Nasal Delivery And Intravenous Injection On Sufentanyl-induced Cough And Preemptive Analgesia

Objective To observe the effects of butorphanol premedication by nasal delivery and intravenous injection on sufentanyl-induced cough before the induction of anesthesia and preemptive analgesia.To investigate the effect of butorphanol premedication on inhibiting sufentanyl-induced cough.Methods In this study,a total of 120 ASAⅠ-Ⅱpatients,aged 25 to 70,body height145 to 175cm,BMI 17 to 32kg/m2,undergoing modified radical mastectomy under general anesthesia were randomly divided into 3 groups:nasally delivered butorphanol group（group A）,intravenously injected butorphanol group（group B）and normal saline group（group C）.There were 40 participants in each group.Electrocardiogram（ECG）,non-invasive blood pressure（NIBP）,heart rate（HR）and pulse oxygen saturation（SpO₂）were monitored on every participant.The three groups were treated as follow:Group A:1mg（1ml）of butorphanol was given intranasally 20min before the induction of anesthesia,and 1ml of normal saline was given intravenously 5min before the induction of anesthesia.Group B:1ml of normal saline was given intranasally 20min before the induction of anesthesia,and 1mg（1ml）of butorphanol was given intravenously 5min before the induction of anesthesia.Group C:1ml of normal saline was given intranasally 20min before the induction of anesthesia,and 1ml of normal saline was given intravenously 5min before the induction of anesthesia.Systolic blood pressure（SBP）,diastolic blood pressure（DBP）,mean arterial pressure（MAP）,heart rate（HR）and Pulse Oxygen Saturation（SpO₂）were recorded after the participant lied quietly for 10minutes（T₀,baseline）,1 min after nasal administration（T₁）,5 min after nasal administration（T2）,10 min after nasal administration（T3）,15 min after nasal administration（T₄）,1 min after intravenous administration（T₅）,3 min after intravenous administration（T6）,5 min after intravenous administration（T7）.The incidence of dizziness,sleepiness,nausea,vomiting,respiratory depression,hypotension and bradycardia were also recorded.Anesthesia was induced with 0.4μg/kg of sufentanil,which was intravenously injected for 5 seconds.SBP,DBP,MAP,HR and SpO₂ were recorded one minute after the intravenous injection of sufentanyl bolus（T₈）,the frequency and intensity of coughing were also recorded.The induction of anesthesia was continued with 2mg/kg of propofol and 0.3mg/kg of cisatracurium.Anesthesia was maintained with 1.0-1.5vol%of sevoflurane,2-4mg/（kg·h）of propofol and0.1-0.2μg/（kg·min）of remifentanil.The duration of anesthesia time,operation time and extubation time were recorded.SBP,DBP,MAP,HR and SpO₂ before（T₉）and after(T₁₀)extubation were also be recorded,as well as the duration of PACU stays and the total dosage of sufentanil,remifentanil and propofol.Analgesia,sedation and comfort scores were scored immediately after waking up（t₁）and before leaving PACU（t₂）.Complications such as postoperative drowsiness,nausea,vomiting,skin itch,respiratory depression,dizziness,urinary retention and so on were observed and recorded in all three groups.Results1.Comparison of general conditions:There were no significant difference in patients characteristics between the three groups（P>0.05）.2.Comparison of sufentanyl-induced cough:（1）The frequency of coughing:The incidence of cough of group A and group B were lower than that in group C（P<0.01）.But there was no significant difference between group A and group B（P>0.05）.（2）The intensity of coughing:The intensity of cough of group A and group B were lower than that in group C（P<0.01）.3.The hemodynamics:（1）Comparison among groups:No significant differences were found in the baseline value of SBP,DBP,MAP,HR and SpO₂ between the three groups（P>0.05）.There was no significant difference in SBP,DBP,MAP and HR among the three groups at all time points（P>0.05）.However,there were statistically significant differences between SpO₂（P<0.05）:atT6-T7,the SpO₂ was lower in group B compared to group A and group C,while there was no significant difference among the three groups at all other time points（P>0.05）.There was no significant difference in SpO₂ between group A and group C at all time points（P>0.05）.（2）Comparison within groups:Compared with T₀,there were no significant difference in SBP,DBP,MAP and HR between the three groups at T₁-T₈（P>0.05）.However,SBP,DBP,MAP and HR in all groups declined at T₉ while ascended at T₁₀ compared to T₀（P<0.05）.Compared with T₀,there was a statistically significant decline of SpO₂ in group B at T₆and T₇（P<0.05）.SpO₂ ascend at T₉ while declined at T₁₀ in all three groups（P<0.05）.4.Comparison of other intraoperative and postoperative outcomes among groups（1）There were no significant differences among the three groups in the duration of anesthesia time,operation time,extubation time and the duration of PACU stays（P>0.05）.（2）There were no significant differences in the total dosage of sufentanil,remifentanil and propofol among the three groups（P>0.05）.（3）There were no significant differences in analgesia,sedation and comfort scores between the three groups immediately after patients waking up（t₁）and before leaving PACU（t₂）（P>0.05）.（4）Adverse events before induction of anesthesia:Dizziness:the incidence of dizziness in group B was significantly higher than that in group A and group C（P<0.05）,while there was no significant difference between group A and group C（P>0.05）.Respiratory depression:the incidence of respiratory depression in group B was significantly higher than that in group A and group C（P<0.05）,while there was no significant difference between group A and group C（P>0.05）.（5）The comparison of postoperative adverse events among groups:There was no significant difference in the incidence of nausea,vomiting,itch skin,respiratory depression,dizziness and urinary retention.（P>0.05）5.Comparison of postoperative analgesia,sedation and comfort scores:there were no statistically significant difference between the three groups in analgesia,sedation and comfort scores（P>0.05）.Conclusion The sufentanyl-induced cough could be effectively inhibited by 1mg of butorphanol premedication through nasal delivery and intravenous injection before the induction of anesthesia.And with butorphanol premedication,there were less postoperative complications and the duration of post-anesthesia recovery was not increased.The decline of oxygen saturation was observed after butorphanol intravenously given,but there was no such kind of side effect observed after nasally delivered butorphanol,and the adverse events occurred less.Premedication butorphanol is effective in postoperative analgesic in patients with modified radical mastectomy.