Clinical And Empirical Observation On Patient-Controlled Intravenous Analgesic Effects Of Butorphanol

CLINICAL AND EMPIRICAL OBSERVATION ON PATIENT-CONTROLLED INTRAVENOUS ANALGESIC EFFECTS OF BUTORPHANOLObjective To observe Clinical effects of patient-controlled intravenous analgesia of butorphanol applied in patients undergoing surgeries of different parts of body and its impacts on IL-6,IL-8 and TNF-α.Methods 1 Clinical Research Ninety ASA(Ⅰ～Ⅱ) patients(20～70 years) undergoing thoracic and abdominal operations without no obvious history of hypertension or hepatic and renal abnormalities were randomly divided into three groups: butorphanol groups(B1,B2) and morphine group(C), thirty patients in each group. Group B1 and group B2 received butorphanol 0.006% and 0.007% , group C received morphine 0.025%. The VAS score , BCS score , Ramsay score, incidence of side effects and actual frequency of PCA pressing were assessed at 5 different time points of 6h(t1),12h(t2),24h(t3),36h(t4),48h(t5) post-operatively .2 Experimental Research According to the results of clinical research, we chose group (butorphanol 0.006%) which had best analgesic effect and fewest adverse reactions. We selected 30 patients who were about to undergo selective operations, aged 20 through 70 years old with their BMIs (Body Mass Index) below 25Kg/m2 while their ASA staging between stages I and II. Then randomly divide the 30 patients into: group butorphanol (group B), group morphine(group M) and group control (group D), 10 patients each group. After surgery, patients from group B and group M were given PCIA whereas, for patients from group D, 0.1g of morphine was administrated when they felt the need. Peripheral venous blood samples were collected at 5 different time points of pre-anesthesia induction(T0), 12h(T1), 24h(T2), 36h(T3), and 48h(T4) post-operatively and levels of IL-6,IL-8 and TNF-αwere measured by enemzy-combined immunosorbernt assay.Results 1 Clinical Research VAS was less than 4 in all groups within 48 hours after surgeries. In the same group, VAS score,actual frequency of PCA pressing and consumption of drug of thoracic patients were significantly higher than(p<0.05) those of lower-abdominal patients. The incidence of headache was highest in thoracic patients, and the incidence of nausea and vomiting was highest in lower-abdominal patients. The incidence of headache, nausea and vomiting was obviously higher in morpnine group than in butorphanol groups(p<0.05).2 Experimental Research Compared to group D, the IL-6,IL-8 and TNF-αlevels of group B and group M were significantly lower (p<0.05).Conclusion 1 The drug consumption in thoracic patients was higher than in lower-abdominal patients.2 The incidence of headache was highest in thoracic patients, and the incidence of nausea and vomiting was highest in lower-abdominal patients.3 The analgesic effect of Butorphanol was similar to that of morphine but butorphanol had few untoward effects.4 Butorphanol and morphine PACI could effectively suppress the increase of levels of IL-6,IL-8 and TNF-αin patients'serum. However ,butorphanol PCIA is more pronounced. BUTORPHANOL IN THE PATIENT-CONTROLLED INTRAVENOUS ANALGESIA : A META-ANALYSIS OF RANDOMIZED CONTROLLED TRIALSObjective To evaluate the effectiveness of the patient-controlled intravenous analgesia for postopeative analgesia and the incidence of side effects.Methods Trials were obtained through electronic searches of the PubMed, Embase, The Cochrane Library and CBM disk (from the date of estabilishment of the databases to October 2008). Randomized controlled trails (RCTs) of butorphanol and morphine or fentanyl for Patient-Controlled intravenous Analgesia were included. The quality of the trials was critically assessed. RevMan 5.0 software was used for meta-analyses.Results Thirteen RCTs involving 802 patients were included, and the quality of all studies was low. Among them, 8 trials compared the clincal effects and adverse effects of the Patient-Controlled intravenous Analgesia with butorphanol and morphine. The results of meta-analyses showed that both butorphanol and morphine have the same clinical effects, butorphanol reduced the occurrence of postoperative nausea and vomitting〔RR=0.30, 95%CI(0.21, 0.42)〕,drowsiness〔RR=0.23, 95%CI(0.07, 0.79)〕and pruritus〔RR=0.23, 95%CI(0.10, 0.54). 5 trials compared the clincal effects and adverse effects of the Patient-Controlled intravenous Analgesia with butorphanol and fentanyl. The results of meta-analyses showed that both butorphanol and fentanyl had the same clinical effects, butorphanol reduced the occurrence of postoperative nausea and vomitting〔RR=0.47, 95%CI(0.32, 0.67)〕.Conclusions The limited current evidence shows that both butorphanol and morphine or fentanyl have the same clinical effects. Compared with morphine, butorphanol has fewer side effects of nausea and vomitting,drowsiness and pruritus. Compared with fentanyl, butorphanol has fewer side effects of nausea and vomitting .