A Comparison Of The Efficacy Of Butorphanol And Fentanyl In Radiofrequency Catheter Ablation Of Atrial Fibrillation

Background and objectiveAtrial fibrilation（AF）is one of the most frequent tachyarrhythmia with high morbidity and mortality.The major complications of atrial fibrillation include stroke,thromboembolic events,cardiovascular adverse events（heart failure and myocardial infarction）,and cognitive impairment.AF is an independent risk factor of stroke and cardiac failure.AF seriously affects the quality of patients’life,with high prevalence of morbidity and mortality.Traditional rhythm control methods（such as drug therapy,Maze surgery,etc.）are not very effective in AF and there is a high recurrence of AF after treatment.Many researchers have found that radio frequency（RF）ablation did avail against AF.And the 2014 guidelines for the management of AF recommend RF ablation as a preferred treatment for paroxysmal AF and persistent AF that does not respond to medication.Although RF ablation is less invasive than the Maze surgery,patient still feels uncomfortable due to the burning sensation caused by radio frequency energy.Besides,long time（2-4 hours）of surgery and keeping a same position also discomfort patient,which may lead patient to be agitated and deeply breathe and even move the body.The discomfort of patient may cause the shifting of radiofrequency catheter and increase the operation difficulty of the surgeon,which increases the prevalence of operative complications and even induces the cardio-cerebrovascular complications.Thus,effective pain management and special anesthetic care are vital during RF ablation of AF.Combination of local anesthetics with sedation drugs（such as medazolam or propofol）and analgesic agents（such as fentanyl or remifentanil）are widely applied in RF ablation and achieve good anesthetic effect.However,opioid,as a kind of analgesic ahents,may cause intraoperative hypotension and respiratory depression.Butorphanol is a kind of synthetic excited-antagonist of opioid receptors with sedative effect and less side effects,which has been widely used in perioperative analgesic.However,the application of butorphanol in the RF ablation of AF is less investigated,The purpose of this study was to investigate the analgesic and sedative effects of butorphanol in transcatheter atrial fibrillation radiofrequency ablation.Details and MethodsEighty patients aged 40-65 years old undergoing RF ablation surgery in the first affiliated Hospital of Zhengzhou University during December 2018 to May 2019were included,with ASA（American Society of Anesthesiologists）I～II,BMI<35,and randomly divided into 2 groups:Fentanyl group:patients received single intravenous injection with 1μg/kg fentanyl at the beginning of surgery and continuous pumping with 1μg/（kg·h）fentanyl.Butorphanol group:patients received a single intravenous injection with 30μg/kg butorphanol at the beginning of surgery.Baseline characteristics of patients,total dosage of butorphanol and fentanyl of the two groups were compared.Heart rate（HR）,mean arterial pressure（MAP）,percutaneous oxygen saturation（Sp O₂）,visual analogue scale（VAS scale）,Ramsay sedation scores were recorded at the following time points:the time of entering operation room（T₀）,the time after injection of analgesic agents（T₁）,the time of beginning the RF ablation（T₂）,the time of RF ablation around the pulmonary vein（T₃）,the time of the procedure is completed（T₄）.Additional analgesic agents injection during surgery and adverse reactions were also observed and recorded.Satisfaction levels of the patients and surgeons were compared.Results1.A total of 80 patients were included and 40 patients were allocated into each group.There was no significant difference in gender,age,BMI,ASA grade and operation time（P>0.05）.2.Comparison of HR,MAP and Sp O₂ between the two groups:there was no significant difference at T₀（P>0.05）.Compared with T₀,Sp O₂ declined at T₁,T₂,T₃and T₄ in the two groups（P<0.05）,and the Sp O₂ in the butorphanol group was significantly lower than that in the fentanyl group from T₁-T₄.There was no significant difference in MAP and HR between the two groups from T₁-T₄（P>0.05）.3.Comparison of Ramsay score and VAS score:Ramsay sedation score in the butorphanol group was significantly higher than that in the fentanyl group at T₂（P<0.05）.VAS score in the butorphanol group was significantly lower than that in the fentanyl group at T₂ and T₃（P<0.05）4.Comparison of the incidence of intraoperative adverse reactions and the effect of anesthesia:there was no statistically significant difference in the incidence of adverse reactions between the two groups（P>0.05）.Respiratory depression occurred in 2（5%）patients,nausea and vomiting occurred in 2（5%）patients,dizziness occurred in 2（5%）patients,and hyperhidrosis occurred in 3（7.5%）patients in the fentanyl group.In the butorphanol group,there were 6（15%）cases of dizziness,5（12.5%）cases of hyperperspiration and 2（5%）cases of blurred vision.Respiratory depression can be corrected by oxygen inhalation,and blurred vision can be relieved by itself after drug metabolism.There was no arrhythmia,itchy skin or excessive sedation between the two groups.Besides,the frequency of using additional drugs in the butorphanol group was significantly lower than that in the fentanyl group（P<0.05）.There was no case that needed to transfer to the general anesthesia due to the poor anesthetic effect.5.The satisfaction levels of the patients and surgeons:The satisfaction levels of patients and surgeons with anesthesia in the butorphanol group were significantly higher than that in the fentanyl group（P<0.05）.Conclusion1.The single injection of 30μg/kg butorphanol was applied to the radiofrequency ablation for patients with AF,which could have a good sedative and analgesic effect.2.Using butorphanol in the radiofrequency ablation of AF can produce satisfactory sedative and analgesic effects without increasing the incidence of anesthesia related adverse reactions.