Dose sparing of induction dose of propofol by fentanyl and butorphanol: A comparison based on entropy analysis

Abstract

Background:The induction dose of propofol is reduced with concomitant use of opioids as a result of a possible synergistic action.Aim and Objectives:The present study compared the effect of fentanyl and two doses of butorphanol pre-treatment on the induction dose of propofol, with specific emphasis on entropy.Methods:Three groups of 40 patients each, of the American Society of Anaesthesiologistsphysical status I and II, were randomized to receive fentanyl 2 μg/kg (Group F), butorphanol 20 μg/kg (Group B 20) or 40 μg/kg (Group B 40) as pre-treatment. Five minutes later, the degree of sedation was assessed by the observer's assessment of alertness scale (OAA/S). Induction of anesthesia was done with propofol (30 mg/10 s) till the loss of response to verbal commands. Thereafter, rocuronium 1 mg/kg was administered and endotracheal intubation was performed 2 min later. OAA/S, propofol induction dose, heart rate, blood pressure, oxygen saturation and entropy (response and state) were compared in the three groups.Statistical Analysis:Data was analyzed using ANOVA test with posthoc significance, Kruskal–Wallis test, Chi-square test and Fischer exact test. A P<0.05 was considered as significant.Results:The induction dose of propofol (mg/kg) was observed to be 1.1±0.50 in Group F, 1.05±0.35 in Group B 20 and 1.18±0.41 in Group B40. Induction with propofol occurred at higher entropy values on pre-treatment with both fentanyl as well as butorphanol. Hemodynamic variables were comparable in all the three groups.Conclusion:Butorphanol 20 μg/kg and 40 μg/kg reduce the induction requirement of propofol, comparable to that of fentanyl 2 μg/kg, and confer hemodynamic stability at induction and intubation.

Effect of Different Doses of Butorphanol on Postoperative Shivering in Elderly Patients: A Randomized, Double-Blind, Placebo-Controlled Trial

“…Butorphanol can produce a certain degree of sedation and may cause somnolence, respiratory depression or hypoxemia. 22,26,38 But in our study, butorphanol did not prolong extubation time or result in excessive postoperative sedation. This may be related to the use of BIS to adjust the depth of sedation during operation.…”

“…Its effect on KOR activation is dose-dependent and has a ceiling effect. 22 Previous studies have proved that…”

“…[32][33][34][35] In addition, butorphanol can make anesthesia induction and recovery more smoothly and reduce the occurrence of postoperative cognitive dysfunction (POCD). 13,22,26 But they did not comprehensively assess the effect of butorphanol on the quality of postoperative recovery. The QoR-40 scale comprehensively assesses the quality of recovery from five clinical dimensions: physical comfort, emotional state, psychological support, physical independence 846 and pain perception.…”

A Comparative Study between Butorphanol and Fentanyl as an Analgesic in Patients Undergoing Abdominal Surgeries under General Anesthesia

“…10,11 Similar findings were reported in studies by Verma RK et al and Kaur J et al, where it was stated that no significant differences were observed between the butorphanol and fentanyl groups in terms of the length of intubation and operation. 5,6 In terms of the hemodynamic response, both the drugs were hemodynamically stable for heart rate, systolic, and diastolic blood pressure, and there was a significant change in the hemodynamic response over time (Table 2). However, it was shown that there was a significant statistical difference in hemodynamic stability between the patients in the butorphanol group and those in the fentanyl group.…”

“…In this study, epidural butorphanol was compared to epidural fentanyl for lower abdominal surgery in terms of efficacy and safety. 5,6 Given the present body of knowledge, it is crucial to find a more efficient agent to reduce pain during propofol induction during abdominal procedures and a more effective agent for hemodynamic stability and the requirement for rescue analgesia. There isn't much research on the topic in this part of the country.…”