Comparison of ED95 of Butorphanol and Sufentanil for Gastrointestinal Endoscopy Sedation: a Randomized Controlled Trial

Abstract

Background: Butorphanol, a synthetic opioid partial agonist analgesic, has been widely used to control perioperative pain. However, the ideal dose and availability of butorphanol for gastrointestinal (GI) endoscopy are not well known. The aim of this study was to evaluated the 95% effective dose (ED95) of butorphanol and sufentanil in GI endoscopy and compared their clinical efficacy, especially regarding the recovery time. Methods: The study was divided into two parts. For the first part, voluntary patients who needed GI endoscopy anesthesia were recruited to measure the ED95 of butorphanol and sufentanil needed to achieve successful sedation before GI endoscopy using the sequential method (the Dixon up-and-down method). The second part was a double-blind, randomized study. Two hundred cases of painless GI endoscopy patients were randomly divided into two groups (n= 100), including group B (butorphanol at the ED95 dose) and group S (sufentanil at the ED95 dose). Propofol was infused intravenously as the sedative in both groups. The recovery time, visual analogue scale (VAS) score, hand grip strength, fatigue severity scores, incidence of nausea and vomiting, and incidence of dizziness were recorded.Results: The ED95 of butorphanol for painless GI endoscopy was 9.07 μg/kg (95% confidence interval: 7.81-19.66 μg/kg). The ED95 of sufentanil was 0.1 μg/kg (95% CI, 0.079-0.422 μg/kg). Both butorphanol and sufentanil provided a good analgesic effect for GI endoscopy. However, the recovery time for butorphanol was significantly shorter than that for sufentanil (P < 0.05, group B vs. group S:21.26 ± 7.70 vs. 24.03 ± 7.80 min).Conclusions: Butorphanol at 9.07μg/kg was more effective than sufentanil for GI endoscopy sedation and notably reduced the recovery time.Trial registration: Chinese Clinical Trail Registry (Registration number # ChiCTR1900022780; Date of Registration on April 25rd, 2019) http://www.chictr.org.cn/showproj.aspx?proj= 37972.

Estimation of effective dose of propofol mono‐sedation for successful insertion of upper gastrointestinal endoscope in healthy, non‐obese Chinese adults

“…However, the assumption of ED 50 is that another 50% of patients will still have movement responses to the UGI endoscope insertion 13 . In order to obtain a more clinically relevant dose of propofol for successful endoscope insertion, we also utilized the probit regression analysis to determine the ED 95 of propofol, a targeted dose that is more likely to inhibit the ‘movement’ responses to the UGI endoscope insertion in most patients 14 …”

“…The MDUDM is a staircase project in which the dose of studied drug for each patient is determined by the response of the previously tested patients. The previous studies had adopted this method to determine the propofol effect‐site targeted concentration at which 50% of patients did not respond to colonoscopy in adults, 12 the median effective dose (ED 50 ) of propofol in combination with different doses of ketamine during the UGI endoscopy in children 13 and ED 95 of opioids drugs for gastrointestinal endoscopy sedation in adult patients 14 . As mentioned above, in our study, the first patient was tested at 1.6 mg/kg propofol and the responses of patient to the endoscope insertion were categorized as either ‘movement’ or ‘no movement’.…”

Advances in the Use of Butorphanol Tartrate in Postoperative Analgesia after Cesarean Section

“…Nowadays, butorphanol is not limited to intraoperative applications, but its use in extra-operative anaesthesia and analgesia has also matured. In painless gastrointestinal endoscopy, the use of butorphanol tartrate not only reduces the incidence of physical movement and coughing in patients, which is conducive to the smooth operation of endoscopy, but also reduces the amount of propofol used, reduces the pain of propofol injections, and reduces the incidence of adverse reactions, such as dizziness, drowsiness, and respiratory depression, and shortens the recovery time of patients [18,19] . The analgesic effect of using Butorphanol for mandibular third molar extraction is significantly better than Tramadol in the dental clinic [20] .…”

Predominant role of gut-vagus-brain neuronal pathway in postoperative nausea and vomiting: evidence from an observational cohort study

“…This might be duo to: 1) dexamethasone being regularly used in premedication along with intra-operative 5HT3 antagonists; 2) su cient anti-emetic (normally 9 mg ondensteron) accompanying opioid analgetics (butorphanol ± fentanyl at much lower dosage) during postoperative patient-controlled analgesia in our hospital. Butorphanol is less likely to cause PONV [24]. Multivariate logistic regression analysis with factors associated with PONV in entire cohort.…”