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Wang Y, Zhao K, Wu N, Ji T, Su G, Cui X, Dong Y, Chen X. Effect of Different Doses of Butorphanol on Postoperative Shivering in Elderly Patients: A Randomized, Double-Blind, Placebo-Controlled Trial. Drug Des Devel Ther 2023; 17:839-849. [PMID: 36969707 PMCID: PMC10038160 DOI: 10.2147/dddt.s396309] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 03/07/2023] [Indexed: 03/29/2023] Open
Abstract
Purpose This study was designed to investigate the effects of different doses of butorphanol on postoperative shivering and quality of recovery in elderly patients. Patients and Methods A total of 147 elderly patients (aged 60 or older) scheduled for elective transurethral resection of the prostate were enrolled in the current study. Patients were randomly and evenly assigned into four groups: Group C (0.9% normal saline), Group B1 (butorphanol 0.01 mg/kg), Group B2 (butorphanol 0.02 mg/kg) and Group B3 (butorphanol 0.03 mg/kg). All drugs were diluted to 5mL and injected intravenously slowly 5 min before induction of anesthesia. The primary outcome measure was the incidence of postoperative shivering in the post-anesthesia care unit. Quality of Recovery-40 (QoR-40) scores were assessed on postoperative day (POD) 1, 2 and 3. Perioperative core and skin temperature, extubation time and adverse events were also recorded. Results Patients among the four groups had comparable baseline characteristics. Compared with Group C, the incidence of shivering was significantly lower in Group B2 and B3 (P = 0.006 and P = 0.005, respectively). The QoR-40 scores on POD1 were significantly higher in all butorphanol groups than that in Group C (P < 0.0083). In Group B2 and B3, patients experienced lower pain intensity (P < 0.001). In addition, the incidence of catheter-related bladder discomfort (CRBD) was lower in all butorphanol groups than in Group C (P < 0.0083). Conclusion Butorphanol 0.02 or 0.03 mg/kg could effectively prevent the occurrence of postoperative shivering in elderly patients scheduled for transurethral resection of the prostate, provided effective postoperative recovery and postoperative analgesia.
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Affiliation(s)
- Yaolin Wang
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Kai Zhao
- Department of Anesthesiology, the First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei, Anhui, People’s Republic of China
- Department of Anesthesiology, Anhui Provincial Hospital, Hefei, Anhui, People’s Republic of China
| | - Nanling Wu
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Tao Ji
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Gaowei Su
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xiaojie Cui
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Yushan Dong
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
| | - Xiuxia Chen
- NMPA Key Laboratory for Research and Evaluation of Narcotic and Psychotropic Drugs, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, Jiangsu, People’s Republic of China
- Correspondence: Xiuxia Chen, Department of Anesthesiology, the Affiliated Hospital of Xuzhou Medical University, Xuzhou, Medical University, Xuzhou, Jiangsu, 221000, People’s Republic of China, Tel +86 18052268332, Email
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Ondansetron Reduces the Incidence of Hypotension after Spinal Anaesthesia: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2022; 15:ph15121588. [PMID: 36559039 PMCID: PMC9787671 DOI: 10.3390/ph15121588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/14/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022] Open
Abstract
Hypotension induced by spinal anaesthesia is a common clinical complication associated with multiple perioperative adverse events. We conducted a systemic review and meta-analysis to confirm whether ondansetron could alleviate hypotension following spinal anaesthesia. PubMed, Embase, Web of Science, and Cochrane Library were searched to identify eligible randomised controlled trials from their respective database inception dates to 30 September 2022. The primary outcome of the meta-analysis was the incidence of hypotension after spinal anaesthesia. The risk of bias in the included studies was evaluated using the revised Cochrane risk of bias tool for randomised trials (RoB 2.0). Grading of Recommendations, Assessment, Development, and Evaluation was applied to assess the level of certainty. A total of 25 studies were included in this research. The meta-analysis revealed that ondansetron significantly decreased the incidence of hypotension (RR = 0.65, 95% CI 0.53−0.80, p < 0.01, I2 = 64%) and bradycardia. In addition, patients treated with ondansetron had a reduced need for vasopressors administration. This study suggests that ondansetron may be recommended as a prophylaxis for hypotension and bradycardia following spinal anaesthesia; the level of evidence was moderate with a high level of heterogeneity.
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Liang D, Shan Y, Wang L. The effect of prophylactic rewarming on postoperative nausea and vomiting among patients undergoing laparoscopic hysterectomy: a prospective randomized clinical study. SAO PAULO MED J 2020; 138:414-421. [PMID: 33053048 PMCID: PMC9673860 DOI: 10.1590/1516-3180.2020.0059.r2.06072020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/06/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Postoperative nausea and vomiting (PONV) is a common complication from general anesthesia that impacts on postoperative recovery. OBJECTIVE To evaluate prophylactic rewarming following general anesthesia, so as to decrease the incidence of PONV among patients undergoing laparoscopic hysterectomy. DESIGN AND SETTING Prospective randomized clinical study at a hospital in China. METHODS Sixty-two patients were randomly assigned into two groups. The forced air warming (FAW) group received pre-warmed Ringer's solution with FAW until the end of surgery. The control group received Ringer's solution without FAW. The pre-warmed Ringer's solution was stored in a cabinet set at 40 °C. The FAW tube was placed beside the patient's shoulder with a temperature of 43 °C. RESULTS Sixty patients completed the study. The FAW group showed significant differences versus the controls regarding temperature. At 6, 24 and 48 hours postoperatively, the incidences of PONV were 53.3%, 6.7% and 3.3% in the FAW group versus 63.3%, 30% and 3.3% in the controls. VAS scores were significantly lower in the FAW group than in the controls at 24 hours (P= 0.035). Forty-item questionnaire total scores in the FAW group were significantly higher than in the controls. The physical independence and pain scores at 24 hours and emotional support and pain scores at 48 hours in the FAW group were higher than in the controls (P < 0.05). There was no difference in hemodynamics or demographics between the two groups (P > 0.05). CONCLUSIONS Prophylactic rewarming relieved PONV and improved the quality of postoperative recovery. CHINESE CLINICAL TRIAL REGISTER (CHICTR) ChiCTR-IOR-17012901.
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Affiliation(s)
- DongDong Liang
- MD. Anesthesiologist, Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai Area, Wenzhou City, Zhejiang Province, China.
| | - YuanLu Shan
- MD. Anesthesiologist, Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai Area, Wenzhou City, Zhejiang Province, China.
| | - Leilei Wang
- MD. Anesthesiologist, Department of Anesthesiology, The First Affiliated Hospital of Wenzhou Medical University, Ouhai Area, Wenzhou City, Zhejiang Province, China.
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Bharathi B, Praveena BL, Krishnaveni KN. Supraclavicular Brachial Plexus Block: Comparison of Varying Doses of Butorphanol Combined with Levobupivacaine - A Double-Blind Prospective Randomized Trial. Anesth Essays Res 2019; 13:174-178. [PMID: 31031501 PMCID: PMC6444942 DOI: 10.4103/aer.aer_190_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Background: The ideal dose of butorphanol for brachial plexus block is not well known. Aims: This study was carried out to evaluate 1 mg and 2 mg of butorphanol added to 0.375% levobupivacaine, with regard to the duration of analgesia. Our study also sought to assess the onset and duration of sensorimotor blockade, hemodynamic effects, sedation, and adverse effects. Settings and Design: This study was a prospective, randomized, double-blinded, and comparative study. Methods: Eighty adult patients of either sex undergoing upper limb surgeries under supraclavicular brachial plexus block were randomly allocated into two groups. Group LB1 received 29 ml of 0.375% levobupivacaine plus 1 mg of butorphanol diluted in 1 ml of normal saline. Group LB2 received 29 ml of 0.375% levobupivacaine plus 2 mg of butorphanol diluted in 1 ml of normal saline. The onset and duration of sensorimotor blockade, level of sedation, duration of analgesia, and adverse effects were assessed. Statistical Analysis: The data were analyzed with Student's t-test and Chi-square test. Results: The onset of sensory (P = 0.032) and motor block (P = 0.026) was earlier in Group LB2 than in Group LB1. The duration of analgesia was significantly prolonged in Group LB2 (643.55 ± 131.6 vs. 511.73 ± 128.6 min; P = 0.001). The incidence of sedation was observed in more number of patients in Group LB2 (P = 0.01). Furthermore, the incidence of nausea, vomiting, and pruritus were observed in more number of patients in Group LB2 (P < 0.05). Conclusion: Higher dose of butorphanol in brachial plexus block hastens the onset and prolongs the duration of sensorimotor blockade and analgesia but is associated with a higher incidence of sedation which requires intense monitoring.
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Affiliation(s)
- B Bharathi
- Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
| | - B Lakshmi Praveena
- Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
| | - K Neela Krishnaveni
- Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
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Nallam SR, Cherukuru K, Sateesh G. Efficacy of Intravenous Ondansetron for Prevention of Postspinal Shivering during Lower Segment Cesarean Section: A Double-Blinded Randomized Trial. Anesth Essays Res 2017; 11:508-513. [PMID: 28663651 PMCID: PMC5490147 DOI: 10.4103/aer.aer_26_17] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background and Aims: Elective lower segment cesarean section under spinal anesthesia is frequently associated with shivering. Ondansetron has been shown to be effective for postspinal shivering. In the present study, we compare the efficacy of ondansetron to prevent postspinal shivering in parturients undergoing cesarean delivery under spinal anesthesia. Materials and Methods: A total of eighty full-term parturients scheduled for elective lower segment cesarean section under spinal anesthesia were randomly allocated into two groups. Group O received 8 mg/4 ml ondansetron, and Group S received 4 ml normal saline intravenously immediately before induction of spinal anesthesia. The level of sensory block, core body temperature, shivering score, and presence or absence of nausea and vomiting during the perioperative period, 1st and 5th min neonates Apgar scores were recorded. The data analysis was carried out with Z-test and Chi-square test. Results: Ten percent (4/40) of patients in Group O and 42.5% (17/40) of patients in Group S had Grade III shivering during the perioperative period and that was treated with intravenous injection tramadol (P = 0.001). Two patients (5%) in ondansetron and 19 patients (47.5%) in control group had nausea and vomiting (P < 0.001) and was treated with intravenous 10 mg metoclopramide. 1st and 5th min Apgar scores of neonates were not statistically different in the groups. Conclusions: Ondansetron is an effective way to prevent shivering, nausea and vomiting during lower segment cesarean section under spinal anesthesia with no effect on Apgar score.
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Affiliation(s)
- Srinivasa Rao Nallam
- Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
| | - Kavya Cherukuru
- Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
| | - Gokul Sateesh
- Department of Anaesthesiology and Critical Care, RIMS, Kadapa, Andhra Pradesh, India
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