Improved patient comfort after transsphenoidal surgery with a modified nasal packing

Abstract

Patient-controlled transnasal butorphanol analgesia following outpatient surgeryTo the Editor:The increasing use of same-day discharge surgery has required that patients be discharged from hospital following more extensive surgical procedures. Butorphanol, a mixed opioid agonist-antagonist, has been shown to provide analgesia similar to parenterally administered narcotics. Rapid absorption and a minimum of respiratory depression suggest that transnasal butorphanol (TNB) may be a useful analgesic following ambulatory surgery.We conducted an open-label, observational study of TNB enrolling 28 ASA I-III patients undergoing a variety of ambulatory procedures at the Ottawa HospitalCivic Campus. Following written, informed, consent patients received a standardized general anesthetic including a prophylactic anti-emetic and a NSAID. Following discharge from the post-anesthesia care unit, patients were instructed to self administer a I mg spray of TNB every 30 min prn to control pain.Total TNB consumed in the postoperative period averaged 4.4 + 2.0 mg. Nausea, sedation, and dysphoria were reported by 10 to 20% of patients. Pain in seven patients could not be adequately controlled following 3 mg TNB administered over 90 min and was treated with parenteral opioids.Previous research has demonstrated that TNB and acetaminophen + codeine (T3) were similarly effective in treating pain following musculoskeletal trauma. Given that TNB did not provide effective analgesia in 25% of patients in this case series it is unlikely that TNB offers sufficient advantage over T3 to justify its expense (CDN$ 80.77 vs CDN$ 11.94). Future research is required to identify a safe, effective, and inexpensive means of treating pain following ambulatory surgery.