Clinical Observation Of Butorphanol Nasal Spray As Postoperative Analgesic In Adults Undergoing Gynecologic Laparotomy

Objective: To evaluate the efficacy and safety of butorphanol nasal spray as postoperative analgesic in adults undergoing gynecologic laparotomy. To compare the advantages and disadvantages of butorphanol intravenous injection and nasal spray in postoperative analgesia.Methods: Ninty patients(18~55 years of age, 50~70kg of weight , ASA ClassⅠorⅡ) undergoing abdominal hysterectomy or myomectomy, were randomly divided into three groups with 30 cases each, including the control group (Group C), the nasal spary group (Group N) and the intravenous injection group (Group V). The drugs used to carry out anesthesia induction included midazolam (0.04mg·kg-1), fentanyl(2μg·kg-1), propofol(2mg·kg-1) and vecuronium(0.1mg·kg-1). During the operation, isoflurane(1.5~2%) , propofol(4~8 mg·kg-1·h-1) and remifentanil(0.1~0.2μg·kg-1·min-1) were used for anesthesia maintenance. Isoflurane was stoped when the abdominal membrane was sutured and the minipump was stoped before the skin was sutured. Postoperative analgesia began at 10~15 minutes before the end of surgery. Patients in the Group N and Group V were given butorphanol nasal spary or intravenous injection 1mg respectively. The Group C was the control group. At the end of surgery, tropisetron was administered intravenously to each patient to prevent postoperative nausea and vomiting , and the residual neuromuscular block was antagonized by atropine and neostigmine. All the patients were given patient-controlled intravenous analgesia (PCIA) after surgery. Vital signs (heart rate, blood pressure, respiratory rate, SpO2), visual analogue pain scale (VAS) , ramsay redation scale (RSS), the usage of patient-controlled analgesia (PCA) and side effects of extubation,1,2,6 and 24 hours after surgery were recorded. The statistical analysis of all data was performed. Results: The age, weight and operation time of the three groups showed no significant differences (P>0.05). VAS of extubation, 1 and 2 hours after surgery, the press times of PCA and total amount of fentanyl of patients in Group N and V were lower than Group C (P﹤0.05). RSS of extubation, 1 and 2 hours after surgery of patients in Group V was higher than Group N and C (P﹤0.05). The incidence of lethargy of patients in Group V was higher than Group N and Group C (P﹤0.05).Conclusions: Butorphanol nasal spray showed good analgesia and sedative effects in adults undergoing abdominal hysterectomy or myomectomy. Compared with intravenous injection, butorphanol nasal spray reduced the incidence of side effects such as excessive sedation and lethargy.