Comparison of Butorphanol with Fentanyl for reducing Etomidate-induced myoclonus: A Prospective, Randomised Clinical Trial

Kewalramani, Alka; Choudhary, Sudhanshu; Kushwaha, R.; Sharma, Nagendra Prasad; Bhate, Sourabh

doi:10.5958/2394-4994.2016.00057.3

Cited by 4 publications

(4 citation statements)

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“…[ 11 12 ] There is a never-ending pursuit among anaesthesiologists to find an ideal drug to attenuate etomidate-induced myoclonus, which would possess attributes like having a short duration of action with minimal systemic effects and without prolonging the duration of anaesthesia. The various agents that have been employed to suppress this effect include midazolam,[ 6 7 ] fentanyl,[ 13 ] remifentanil,[ 14 ] magnesium sulphate,[ 10 15 ] lignocaine,[ 16 ] butorphanol,[ 3 9 17 18 ] dexmedetomidine,[ 1 2 8 19 20 21 22 ] thiopental[ 21 ] and sub-hypnotic doses of etomidate. [ 23 ] Dexmedetomidine has the edge over the other agents, given its diverse actions, including conscious sedation, analgesia and preventing haemodynamic response to laryngoscopy and intubation.…”

Section: Discussionmentioning

confidence: 99%

Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study

Rautela,

Gulabani,

Kumar

et al. 2023

Indian Journal of Anaesthesia

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Background and Aims: Etomidate is a popular induction agent, but its use is associated with myoclonus in 50%–80% of non-premedicated patients. This study aims to compare dexmedetomidine and butorphanol for their relative efficacy in preventing etomidate-induced myoclonus. Methods: This randomised study was conducted after obtaining institutional ethical committee clearance and written informed consent from sixty American Society of Anesthesiologists (ASA) I or II consenting patients between 18 and 60 years of age of either sex who had been scheduled for elective surgeries under general anaesthesia. Patients were randomly allocated to dexmedetomidine 0.5 μg/kg (Group D) or butorphanol 0.015 mg/kg (Group B). Both the drugs were given as an infusion over a period of 10 min before induction of anaesthesia. The primary outcome was the incidence of myoclonic movements after etomidate, and the secondary outcomes were the severity of myoclonus, changes in the haemodynamic parameters and incidence of airway complications. Normally distributed variables were compared using Student’s t-test, and non-normally distributed variables were compared using Mann–Whitney U test. Qualitative data were analysed using Chi-square/Fisher’s exact test. A P-value <0.05 was considered significant. Results: The incidence of etomidate-induced myoclonus was significantly higher in group B compared to group D (P = 0.035). The median (interquartile range [IQR]) of myoclonus grade in patients of group D was 0.00 (0.00–3.00), and group B was 2.50 (0.00–3.00) (P = 0.035). Haemodynamics and airway-related complications were comparable between the groups. Conclusion: Dexmedetomidine was more effective than butorphanol in preventing etomidate-induced myoclonus.

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Section: Discussionmentioning

confidence: 99%

Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study

Rautela,

Gulabani,

Kumar

et al. 2023

Indian Journal of Anaesthesia

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“…Study done by Kewalramani et al . [16] compared butorphanol and fentanyl administered before the induction of etomidate to reduce the myoclonic movements. Incidence of myoclonus was 6.7% and 10%, respectively, and hence, they concluded that the incidence and severity of etomidate-induced myoclonus were better reduced by combination of midazolam with butorphanol than midazolam with fentanyl if administered before induction.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies done with butorphanol having similar characteristics like nalbuphine also justify the action of nalbuphine in decreasing the incidence of myoclonus by etomidate. [1617]…”

Section: Discussionmentioning

confidence: 99%

“…With this background, we planned this study and chosen fentanyl and nalbuphine as there have been no reported comparison studies between fentanyl and nalbuphine as a better pretreatment option in the prevention of myoclonus due to etomidate. However, other agonist-antagonist butorphanol[1617] has been compared with fentanyl[16] in preventing etomidate-induced myoclonus but no study till date has been done comparing fentanyl and nalbuphine, so we made an effort in the present study to compare these two opioids. Hence, in this study, we have compared the potency of fentanyl and nalbuphine in terms of prevention of etomidate-induced myoclonus which is the primary outcome of this study.…”

Section: Introductionmentioning

confidence: 99%

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Effect of fentanyl and nalbuphine for prevention of etomidate-induced myoclonus

et al. 2019

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Background: Etomidate is a potent intravenous inducing agent with known undesirable side effects such as myoclonus and pain on injection in nonpremedicated patients. Aims: The aim of this study is to compare the effect of fentanyl and nalbuphine in the prevention of etomidate-induced myoclonus. Settings and Design: Randomized double-blind, placebo-controlled, and prospective comparative study. Materials and Methods: A total of 120 patients were randomly allocated to one of the three groups containing 40 patients each for intravenous administration of fentanyl 2 μg/kg diluted in 10 mL normal saline (NS) (Group 1), nalbuphine 0.3 mg/kg diluted in 10 mL NS (Group 2), and only 10 mL NS (Group 3) over 10 min. All groups subsequently received 0.3 mg/kg etomidate by intravenous bolus injection over 15–20 s and were assessed for the severity of pain using Grade IV pain scale and observed for myoclonus for 2 min and graded according to clinical severity. Serum creatinine phosphokinase (CPK) levels were obtained prior and postetomidate injection. Statistical Analysis: Statistical analysis was performed by the SPSS program version 17.0 for Windows. Tests used are Shaipro–Wilk test, ANOVA, Tukey's multiple comparison test, Tamhane's T2, and the Chi-square test. For all statistical tests, P < 0.05 was considered statistically significant with 5% level of significance (α). Results: The incidence of myoclonus in Group 1 and 2 was 52.5% and 17.5%, respectively, whereas it was 92.45% in Group 3. There was no pain observed in 70%, 92.5%, and 50% of patients in Group 1, 2, and 3, respectively. There was a statistically significant difference in mean CPK level after induction among three groups ( P < 0.001). Conclusion: Nalbuphine is more effective than fentanyl in the prevention of etomidate-induced myoclonus and pain with the minimum rise in CPK levels.

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Effect of pre-treatment on induction of anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination

Sojitra,

Kantharia,

Nakum

et al. 2023

Current Medicine Research and Practice

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Background: Because of its prompt onset of action and clearance, the use of etomidate as an anaesthetic induction agent is increasing in clinical practice. However, etomidate-induced myoclonus (EIM) remains a prevalent issue. Such myoclonic activity can be prevented by the administration of drugs that inhibit subcortical neuronal activity. Aims: This study was designed to compare the effects of pre-treatment with dexmedetomidine and fentanyl–midazolam combination on EIM as well as on attenuation of pharyngolaryngeal reflex. Materials and Methods: One hundred adult patients with the American Society of Anesthesiologists Grades 1 or 2 posted for elective surgery were enrolled and were randomly divided into two groups of 50 patients each. Group D received dexmedetomidine (1 μg/kg) in over 10 min and Group F received midazolam (0.02 mg/kg) + fentanyl (2 μg/kg) intravenously. Haemodynamic variables, incidence and severity of myoclonus were recorded. Results: The incidence of EIM was lower in Group F (26%) when compared to Group D (40%), but the difference was not statistically significant (P = 0.28). Eighteen per cent of the subjects in Group F had Grade 1 myoclonus as compared to 32% of Group D, whereas 8% of the subjects in Group F had Grade 2 myoclonus as compared to 6% of Group D. None of the patients in Group F experienced myoclonus of Grade 3, whereas 2% of the subjects had Grade 3 myoclonus. Conclusion: Administration of a combination of fentanyl and midazolam, along with dexmedetomidine as a pre-treatment, has been found to be an effective strategy for mitigating the incidence of myoclonus.

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Comparison of Butorphanol with Fentanyl for reducing Etomidate-induced myoclonus: A Prospective, Randomised Clinical Trial

Cited by 4 publications

References 0 publications

Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study

Comparative assessment of dexmedetomidine and butorphanol for attenuation of etomidate-induced myoclonus: A double-blind, randomised controlled study

Effect of fentanyl and nalbuphine for prevention of etomidate-induced myoclonus

Effect of pre-treatment on induction of anaesthesia with etomidate: A comparison between dexmedetomidine and midazolam–fentanyl combination

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