AUTHOR=Meng Tao , Lin Xiaowen , Li Ximing , Yue Fangli , Zhang Yuzhu , Wang Yingbin , Gu Jianhua , Yang Zaiqi , Yu Hongli , Lv Kun , Liang Shengyong , Li Xingda , Zhu Weibo , Yu Gang , Li Tao , Ren Yujia , Li Yandong , Xu Jianjun , Xu Weimin , Wang Shu , Wu Jianbo 

TITLE=Pre-anesthetic use of butorphanol for the prevention of emergence agitation in thoracic surgery: A multicenter, randomized controlled trial

JOURNAL=Frontiers in Medicine

VOLUME=9

YEAR=2022

URL=https://www.frontiersin.org/journals/medicine/articles/10.3389/fmed.2022.1040168

DOI=10.3389/fmed.2022.1040168

ISSN=2296-858X

ABSTRACT=<sec><title>Background</title><p>Emergence agitation (EA) is common in patients after general anesthesia (GA) and is associated with poor outcomes. Patients with thoracic surgery have a higher incidence of EA compared with other surgery. This study aimed to investigate the impact of pre-anesthetic butorphanol infusion on the incidence of EA in patients undergoing thoracic surgery with GA.</p></sec><sec><title>Materials and methods</title><p>This prospective randomized controlled trial (RCT) was conducted in 20 tertiary hospitals in China. A total of 668 patients undergoing elective video-assisted thoracoscopic lobectomy/segmentectomy for lung cancer were assessed for eligibility, and 620 patients were enrolled. In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. Patients in the intervention group received butorphanol 0.02 mg/kg 15 min before induction of anesthesia. Patients in the control group received volume-matched normal saline in the same schedule. The primary outcome was the incidence of EA after 5 min of extubation, and EA was evaluated using the Riker Sedation-Agitation Scale (RSAS). The incidence of EA was determined by the chi-square test, with a significance of <italic>P</italic> &lt; 0.05.</p></sec><sec><title>Results</title><p>In total, 296 patients who received butorphanol and 306 control patients were included in the intention-to-treat analysis. The incidence of EA 5 min after extubation was lower with butorphanol treatment: 9.8% (29 of 296) vs. 24.5% (75 of 306) in the control group (<italic>P</italic> = 0.0001). Patients who received butorphanol had a lower incidence of drug-related complications (including injecting propofol pain and coughing with sufentanil): 112 of 296 vs. 199 of 306 in the control group (<italic>P</italic> = 0.001) and 3 of 296 vs. 35 of 306 in the control group (<italic>P</italic> = 0.0001).</p></sec><sec><title>Conclusion</title><p>The pre-anesthetic administration of butorphanol reduced the incidence of EA after thoracic surgery under GA.</p></sec><sec><title>Clinical trial registration</title><p>[<ext-link ext-link-type="uri" xlink:href="http://www.chictr.org.cn/showproj.aspx?proj=42684" xmlns:xlink="http://www.w3.org/1999/xlink">http://www.chictr.org.cn/showproj.aspx?proj=42684</ext-link>], identifier [ChiCTR1900025705].</p></sec>