OBJECTIVETo investigate the preemptive analgesic efficiency of parecoxib in patients undergoing laparoscopic colorectal surgery.

METHODSForty ASA I-II patients aged 30 to 64 years undergoing laparoscopic colorectal surgery were randomized to receive either intravenous parecoxib sodium (40 mg) at anesthesia induction (group A) or intravenous parecoxib sodium (40 mg) 30 min before the completion of surgery (group B). Butorphanol was administered by patient-controlled analgesia for postoperative analgesia. The intensity of pain measured by VAS score was recorded at 2, 4, 6, 8, 12, and 24 h after the operation. The number of unsatisfied demand and the number of successfully delivered doses, butorphanol consumption at 12 h and 24 h after the operation, the patients' global evaluation of the postoperative analgesia and the number of the patients receiving rescue medication and adverse effects related to analgesia were recorded and compared between the two groups.

RESULTSThe VAS scores at different time points were significantly lower in group A than in group B (P<0.05). The number of unsatisfied demand and the number of successfully delivered doses were significantly higher and butorphanol consumption at 12 h and 24 h after the operation was significantly less in group A (P<0.05). The incidence of adverse events was similar between the two groups.

CONCLUSIONAdministration of 40 mg parecoxib sodium at anesthesia induction in the patients undergoing laparoscopic colorectal surgery can result in significant preemptive analgesia.

Adult ; Analgesia ; methods ; Analgesia, Patient-Controlled ; Analgesics, Opioid ; administration & dosage ; Butorphanol ; administration & dosage ; Colorectal Surgery ; Humans ; Isoxazoles ; administration & dosage ; Laparoscopy ; Middle Aged

OBJECTIVETo evaluate the efficacy and safety of continuous epidural analgesia (CEA) with butorphanol in elderly patients undergoing hip replacement.

METHODSSixty patients scheduled for selective hip replacement were randomized into group B (n=30) to receive patient-controlled epidural analgesia (PCEA) with butorphanol and group M (n=30) to receive PCEA with morphine. Their pain distribution at 5 time points, postoperative global score and the adverse effects in 48 h were observed.

RESULTSThe pain distribution at the 5 time points or the global score for postoperative PCEA in 48 h showed no statistically significant difference between the two groups (P<0.05). Analgesia with butorphanol caused less adverse effects (respiratory depression, nausea and vomiting, itching and abdominal distension) than that with morphine (P<0.05).

CONCLUSIONCEA with butorphanol is safe and effective for the treatment of postoperative pain in elderly patients and causes less adverse effects than morphine.

Aged ; Aged, 80 and over ; Analgesia, Epidural ; Arthroplasty, Replacement, Hip ; adverse effects ; Butorphanol ; administration & dosage ; therapeutic use ; Female ; Humans ; Male ; Middle Aged ; Morphine ; administration & dosage ; therapeutic use ; Pain, Postoperative ; etiology ; prevention & control

OBJECTIVE: To determine an optimal clinical dose of ketamine after comparing the efficacy and security of 3 low dose ketamines mixed with butorphanol in the postoperative continuous intravenous analgesia. METHODS: Eighty ASA (American Society of Anesthesiologists) I-II patients scheduled for elective gynecological surgery under general anesthesia were divided randomly into 4 groups (n=20): Group B received butorphanol 3 microg/(kg x h);Group BK1 received butorphanol 2 microg/(kg x h) mixed with ketamine 60 microg/(kg x h); Group BK2 received butorphanol 2 microg/(kg x h) mixed with ketamine 90 microg/(kg.h); and Group BK3 received butorphanol 2 microg/(kg x h) mixed with ketamine 120 microg/(kg x h). Continuous intravenous infusion pump was used when the patients had obvious pain (visual analgesia scale of five), and the bolus infusion (4 mL) was given before the operation, and continuous infusion at 2 mL/h. In the postoperative period, pain was assessed using visual analogue scale (VAS) at 2,6,12,24, and 48 h.At the same time, Ramsay scores and adverse effects were recorded. RESULTS: There was no significant difference in the adverse effects and the postoperative mean arterial pressure, heart rate, respiratory rate values, and pulse oxygen among the 4 groups. Postoperative VAS values in Group BK3 was the lowest, followed by Group BK2. There was no significant difference between Group BK1 and Group B. The incidence of somnolence in Group B was higher than that in Group BK1, BK2 and BK3(P<0.05). CONCLUSION Ketamine in subanaesthetic dose added to butorphanol for postoperative continuous intravenous infusion has a better postoperative analgesic effect and sedation. It can effectively spare butorphanol consumption without increasing adverse effects. The optimal combined dose is 90-120 microg/(kg x h).
Adult ; Analgesia ; methods ; Analgesics ; administration & dosage ; Butorphanol ; administration & dosage ; Dose-Response Relationship, Drug ; Drug Therapy, Combination ; Female ; Gynecologic Surgical Procedures ; Humans ; Infusions, Intravenous ; Ketamine ; administration & dosage ; Pain, Postoperative ; drug therapy

BACKGROUND: The aim of this study was to investigate the effect of butorphanol on the Bispectral Index (BIS) during the administration of intravenous anesthesia with propofol and remifentanil. METHODS: Forty adult patients, ASA I-II, scheduled for an emergency laparoscopic appendectomy were studied. The doses for the anesthetics were adjusted to keep the BIS value between 40 and 50. After 20 minutes of stable anesthesia, the subjects were randomly allocated to receive intravenous saline (control group) or 0.02 mg/kg butorphanol (butorphanol group). The BIS values, mean arterial pressure, and heart ratewere recorded every five minutes for a period of 20 minutes. RESULTS: The mean BIS values after butorphanol administration were not significantly different from the values following the administration of saline, throughout the observation period. No patients were able to recall explicitly any events under anesthesia. No significant changes in mean arterial pressure and heart rate were noted after butorphanol administration. CONCLUSIONS: Butorphanol given to prevent postoperative pain does not modify the BIS value during anesthesia maintained with remifentanil and propofol.
Adult ; Anesthesia ; Anesthesia, Intravenous* ; Anesthetics ; Appendectomy ; Arterial Pressure ; Butorphanol* ; Emergencies ; Heart ; Heart Rate ; Humans ; Pain, Postoperative ; Propofol*

BACKGROUND: Severe postoperative pain can delay knee rehabilitation and prolong the duration of convalescence after a total knee replacement (TKR). This study compared a continuous 3-in-1 block using a patient-controlled analgesia (PCA) technique and IV PCA for analgesia after a unilateral TKR. METHODS: Forty patients scheduled for an elective TKR under spinal anesthesia were randomly divided into two groups. Group 1 received an IV PCA with butorphanol and ketorolac. Group 2 received a continuous 3-in-1 block performed with 20 ml of 0.25% bupivacaine and epinephrine 1 : 200,000, followed by a continuous infusion of 0.125% bupivacaine through a femoral catheter at a rate of 2 ml/h plus 1 ml PCA boluses of a lockout time of 10 min. The level of pain was assessed at rest and during continuous passive motion using a visual analog scale (VAS). The VAS pain scores, nausea and vomiting were recorded in the postanesthetic care unit, at 6 PM on the day of operation, and at 8 AM and 6 PM on postoperative days 1 and 2, respectively. The duration of surgery, anesthesia time, blood loss, and hospital stay were compared. RESULTS: The patients in Group 2 reported lower VAS pain scores than those in Group 1 (P < 0.05). The duration of surgery, nausea and vomiting, blood loss, and hospital stay were similar in the two groups except for the anesthesia time. CONCLUSIONS: A continuous 3-in-1 block with a PCA technique provides better pain relief than IV PCA with butorphanol and ketorolac after TKR.
Analgesia ; Analgesia, Patient-Controlled* ; Anesthesia ; Anesthesia, Spinal ; Arthroplasty, Replacement, Knee* ; Bupivacaine ; Butorphanol ; Catheters ; Convalescence ; Epinephrine ; Humans ; Ketorolac ; Knee ; Length of Stay ; Nausea ; Pain, Postoperative* ; Passive Cutaneous Anaphylaxis ; Rehabilitation ; Visual Analog Scale ; Vomiting

BACKGROUND: Butorphanol, a synthetic partial agonist-antagonist narcotic, produces adequate analgesia for postoperative pain. This study was designed to determine the appropriate dosage of butorphanol when administered with ketorolac by intravenous patient controlled analgesia (IV-PCA) after subtotal gastrectomy. METHODS: Ninety ASA physical status I or II patients undergoing subtotal gastrectomy were randomly allocated into one of three groups according to type of drug used (n = 30 for each group). The patients were divided into group B6 (butorphanol 6 mg), group B10 (butorphanol 10 mg) and group B14 (butorphanol 14 mg). Drugs for each group were mixed with 300 mg of ketorolac and normal saline (total amount: 100 ml) for infusion. Bolus dose, maintenance dose and lockout interval were 0.5 ml per each press, 1 ml/hr and 15 minutes, respectively. In each group, numerical rating scale (NRS) score, sedation score and incidence of side effect were checked. RESULTS: There were no significant differences in analgesic effects and sedation score among three groups but the NRS score of group B14 is lower than that of group B6 (P < 0.05) 3 hrs after the recovery room. CONCLUSIONS: We recommend 6 mg butorphanol, mixed with 300 mg of ketorolac, and normal saline for postoperative pain relief using IV-PCA.
Analgesia ; Analgesia, Patient-Controlled* ; Butorphanol* ; Gastrectomy* ; Humans ; Incidence ; Ketorolac ; Pain, Postoperative ; Recovery Room

BACKGROUND: Neuroaxial morphine may produce nausea and vomiting due to cephalad migration. Though it improves post- operative pain, it may have serious complication delaying recovery. The aim of this study was to investigate the efficacy of prophylactic antiemetics such as conventional metoclopramide or more expensive ondansetron. METHODS: Eighty-seven patients who underwent orthopedic knee arthroscopic surgery under epidural anesthesia were randomly assigned to three groups, which are (a) normal saline intravenous injection control group (Group C), (b) metoclopramide intravenous injection and intranasal spray study group (Group M), (c) ondansetron inravenous injection group (Group O). Before the end of surgery, all patients were given 3 mg of morphine and 2 mg of butorphanol mixture via epidural catheter for postoperative pain control. The anesthesia were all standardized. Post-operative nausea and vomiting were observed and used as outcome variables and postoperative pain, itching, somnolence, dizziness, urinary retention were also observed. RESULTS: The incidence of postoperative nausea was significantly lower in Group M (P = 0.0296) and Group O (P = 0.005) compared with Group C. The incidence of postoperative vomiting was significantly lower in Group O (P = 0.01) compared with Group C. But statistically no difference was noted in vomiting between Group C and Group M (P = 0.0579). CONCLUSIONS: The results suggest that ondansetron and metoclopramide are effective in reducing the incidence of post-operative nausea. But ondansetron is more effective in reducing the incidence of post-operative morphine induced vomiting.
Anesthesia ; Anesthesia, Epidural ; Antiemetics ; Arthroscopy ; Butorphanol ; Catheters ; Dizziness ; Humans ; Incidence ; Injections, Intravenous ; Knee ; Metoclopramide* ; Morphine ; Nausea ; Ondansetron* ; Orthopedics ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Pruritus ; Urinary Retention ; Vomiting

BACKGROUND: Despite new anesthetic drugs and antiemetics, the incidence of postoperative nausea and vomiting remains between 20% and 70%. The authors tested the hypothesis that seasonal diet and temperature change and preoperative gastric emptying time affects the incidence of postoperative nausea and vomiting. METHODS: We conducted a retrospective cohort study of 626 women had undergone laparoscopic hysterectomy. Patients were anesthetized with nitrous oxides and inhalation anesthetics or propofol and injected butorphanol or nalbuphine or patient-controlled analgesia for postoperative pain control. Data were collected from records of recovery room and ward nurse's record and analysed with student t-test or chi-square test and logistic regression. Results are presented as mean +/- SD; P <0.05 was considered significant. RESULTS: The incidence of PONV was 19.2%. Younger age, intraoperative dehydration, non-anemic preoperative state, usage of nalbuphine increase the incidence of PONV. But the incidence of PONV was not increased by type of anesthetic agent (inhalation or propofol), BMI, duration of operation, preoperative gastric emptyng time. CONCLUSION: There are controversy in cause of PONV. Further well-controlled, double-blind prospective study may be needed.
Analgesia, Patient-Controlled ; Anesthetics ; Anesthetics, Inhalation ; Antiemetics ; Butorphanol ; Cohort Studies ; Dehydration ; Diet ; Female ; Gastric Emptying ; Gynecologic Surgical Procedures ; Humans ; Hysterectomy* ; Incidence ; Laparoscopy ; Logistic Models ; Nalbuphine ; Oxides ; Pain, Postoperative ; Postoperative Nausea and Vomiting* ; Propofol ; Recovery Room ; Retrospective Studies ; Seasons

BACKGROUND: In many cases, spinal anesthesia is performed in cesarean section. Many women want postoperative pain control. The purpose of this study was to compare the effects of intravenous patient-controlled analgesia (IV-PCA) and epidural patient-controlled analgesia (Epi-PCA) in patients undergoing cesarean section with spinal anesthesia. METHODS: Forty healthy women were randomly assigned to receive IV-PCA or Epi-PCA after cesarean section with spinal anesthesia. The IV-PCA group received ketorolac 30 mg and butorphanol 0.5 mg intravenously when the peritoneum was sutured, followed by IV-PCA with 0.15% ketorolac and 0.005% butorphanol 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The Epi-PCA group received 0.01% morphine 10 ml via an epidural catheter when the peritoneum was sutured, followed by Epi-PCA with 0.004% morphine and 0.1% bupivacaine 100 ml (basal infusion rate 2 ml/hr, bolus 2 ml, lock-out time 15 mins). The degree of pain was subjectively evaluated using a visual analogue scale (VAS). Patients were evaluated at 2, 6, 12, 24 and 48 hours after operation. Statistical analyses were performed using T-test, Mann White U test and the Chi-square test. RESULTS: VAS was not significantly different at any time, and the incidences of pruritus and sensory and motor changes of the lower extremities were significantly higher in Epi-PCA than IV-PCA. CONCLUSIONS: Although VAS in the two groups was not significantly different, we conclude that IV-PCA is more beneficial than Epi-PCA in patients undergoing cesarean section with spinal anesthesia, because of the side effects of Epi-PCA.
Analgesia, Patient-Controlled* ; Anesthesia, Spinal* ; Bupivacaine ; Butorphanol ; Catheters ; Cesarean Section* ; Female ; Humans ; Incidence ; Ketorolac ; Lower Extremity ; Morphine ; Pain, Postoperative ; Passive Cutaneous Anaphylaxis ; Peritoneum ; Pregnancy ; Pruritus

BACKGROUND: Ondansetron is a specific 5-hydroxytrypamine (HT3) receptor antagonist, sodium channel blocker and mu-opioid receptor agonist. Prophylactic intravenous administration of ondansetron has an antiemetic effect in general and epidural anesthesia. This study is designed to evaluate the antiemetic effect of intravenous ondansetron in patient-controlled epidural analgesia (PCEA) patients. METHODS: Sixty ASA physical status I-II patients undergoing elective cesarean section under epidural anesthesia using 0.75% ropivacaine and fentanyl 50microgram were received intravenous fentanyl 50microgram plus ondansetron 2 mg (group 2 mg: n = 20), 4 mg (group 4 mg: n = 20) or 8 mg (group 8 mg: n = 20) after delivery of baby. PCEA was started using 0.15% ropivacaine and 50microgram/ml butorphanol (total volume: 300 ml, 4 ml of bolus dose, and 10 min of lockout interval). The intraoperative and postoperative incidence and severity of nausea and vomiting were recorded using 4 point scale (0: none, 1: mild, 2: moderate, 3: severe) for postoperative 24 hours. RESULTS: There were no significantly lower incidence and severity of nausea and vomiting in group 8 mg (10%, 5%) than group 2 mg (25%, 10%), and group 4 mg (20%, 10%) during postoperative 24 hours. CONCLUSIONS: Prophylactic intravenous ondansetron 8 mg injection with PCEA drug has no superior antiemitic effect than 2 mg or 4 mg in cesarean section patients under PCEA without significant side effects.
Administration, Intravenous ; Analgesia, Epidural* ; Anesthesia, Epidural ; Antiemetics ; Butorphanol ; Cesarean Section* ; Female ; Fentanyl ; Humans ; Incidence ; Nausea ; Ondansetron* ; Postoperative Nausea and Vomiting* ; Pregnancy ; Sodium Channels ; Vomiting