Dexmedetomidine Combined With Butorphanol or Sufentanil for the Prevention of Post-operative Nausea and Vomiting in Patients Undergoing Microvascular Decompression: A Randomized Controlled Trial

Abstract

Background: Patients undergoing microvascular decompression are often accompanied with high risk of post-operative nausea and vomiting (PONV). In this study, we compare the antiemetic efficacy of butorphanol or sufentanil combined with dexmedetomidine in patients undergoing microvascular decompression.Methods: Patients undergoing microvascular decompression were randomized into two groups. The primary outcome was the occurrence and severity of PONV during the 72 h after surgery. Secondary outcomes included levels of pain intensity and sedation and consumption of opioids at 1, 2, 6, 12, 24, 48, and 72 h after surgery. We also recorded the intraoperative hemodynamics, consumption of narcotic drugs, operation and anesthesia time, estimated blood loss, infusion volume and urine output, requirements of rescue antiemetics or analgesics, the satisfaction scores of patients and surgeons, complications, and length of stay.Results: The overall incidence rates of nausea and vomiting during the 72 h after surgery were significantly reduced in group DB (76.00 and 44.00% in group DS vs. 54.17% and 22.92% in group DB, P < 0.05). Patients in group DB had a lower incidence of nausea than those in group DS at intervals of 1-6 and 6-24 h (P < 0.05). However, patients in group DB had a lower incidence of vomiting than those in group DS only at intervals of 1-6 h (P < 0.05). Similarly, the number of patients requiring rescue antiemetics was also significantly reduced in group DB compared with that in group DS at intervals of 1-6 h (P < 0.05). The number of patients experiencing moderate to severe PONV was comparable between the two groups during 72 h after surgery (P > 0.05). The consumption of opioid morphine equivalent was significantly reduced in group DB (P < 0.05). Compared with those in group DS, the satisfaction scores of both patients and surgeons were significantly increased in group DB (P < 0.05). Xu et al.Butorphanol or Sufentanil for PONV Conclusion: Butorphanol combined with dexmedetomidine could reduce early PONV and the number of patients requiring rescue antiemetics, especially at intervals of 1-6 h, while the satisfaction scores of both patients and surgeons were significantly increased.

Safety and Efficacy of Butorphanol as an Analgesic for Patients on Mechanical Ventilation after Cardiac Surgery: An Exploratory Prospective Observational Study

“…Butorphanol may also protect the myocardium [20] and help stabilize hemodynamic parameters [21], especially when administered with propofol [22]. Comparison of the effects of butorphanol with those of the opioid tramadol in women after receiving a cesarean section showed that butorphanol had significantly better analgesic activity as well as significantly lower risk of nausea, vomiting, dizziness, and 24-hour sedation after analgesia [23], leading to significantly higher patient satisfaction [24].…”

Dexmedetomidine combined with sufentanil in intravenous controlled analgesia after hip arthrotomy in children

“…From the injured tissue, which results in peripheral sensitization and increases the pain effect. Substance P (SP) is a key factor in pain signal transduction, which plays a signal transduction role in nerve conduction [27] . Dexmedetomidine has an analgesic effect by inhibiting the release of substance P and other nociceptive substances from the presynaptic membrane of the descending medulla-spinal NE pathway.…”

Antiemetic Prophylaxis with Ramosetron for Postoperative Nausea and Vomiting in Patients Undergoing Microvascular Decompression : A Prospective, Randomized Controlled Trial

“…Thus, surgical manipulation may predispose patients to PONV after MVD [ 21 ]. Several studies have been conducted to prevent PONV in patients undergoing MVD [ 23 , 25 ].…”