The effects of fentanyl, oxycodone, and butorphanol on gastrointestinal function in patients undergoing laparoscopic hysterectomy: a prospective, double-blind, randomized controlled trial

Minna Guo, Shijiang Liu, Jian Gao, Chuanbao Han, Chun Yang, Cunming Liu, Minna Guo, Shijiang Liu, Jian Gao, Chuanbao Han, Chun Yang, Cunming Liu

Abstract

Background: Perioperative opioid use is associated with postoperative bowel dysfunction, which causes longer hospital stay and higher healthcare costs. This study aimed to investigate the effect of the equivalent doses of fentanyl, oxycodone, and butorphanol on bowel function in patients undergoing laparoscopic hysterectomy.

Methods: In this randomized controlled trial, 135 patients undergoing laparoscopic hysterectomy received postoperative intravenous patient-controlled analgesia (IV-PCA) with fentanyl 8.3 μg/kg, butorphanol 0.16 mg/kg, and oxycodone 0.5 mg/kg (1: 20: 60), respectively. The primary outcome measure was the recovery of bowel function. We also evaluated and recorded the following nine indicators: pain score, sedation level, leukocyte count, percentage of neutrophils, plasma potassium levels, time to first ambulation, postoperative side effects, patients' satisfaction, and postoperative hospital length of stay.

Results: The mean time to flatus was significantly prolonged in Group B (45.2 ± 11.6 h) compared with Group F (33.1 ± 11.2 h, P < 0.001) and Group O (36.2 ± 10.9 h, P = 0.001). The incidence of somnolence and dizziness prove higher in Group B (P < 0.001). No statistical difference was observed in the mean time to tolerate oral diet, time to defecation, analgesic outcome, satisfaction score, time to first ambulation, and postoperative hospital length of stay.

Conclusions: Compared with fentanyl and oxycodone, butorphanol prolonged the recovery of bowel function with more severe somnolence and dizziness, suggesting that butorphanol is not well suitable for IV-PCA in patients undergoing laparoscopic hysterectomy.

Trial registration: ClinicalTrials.gov- NCT04295109 . Date of registration: March, 2020.

Keywords: Analgesia; Opioid receptor; Postoperative gastrointestinal tract dysfunction.

Conflict of interest statement

The authors declare that they have no competing interests.

© 2022. The Author(s).

Figures

Fig. 1
Fig. 1
Consort flow diagram. Abbreviations: B = butorphanol; CONSORT = Consolidated Standards of Reporting Trials; F = fentanyl; IV-PCA = intravenous patient-controlled analgesia; O = oxycodone.
Fig. 2
Fig. 2
The recovery of bowel function. A Box plot comparing the mean time to flatus (measured from surgery). The mean time to flatus significantly longer in the group B (***P < 0.001, Group F versus Group B, **P < 0.01, Group O versus Group B, one-way ANOVA, followed by Bonferroni’s post hoc test). B. Box plot comparing mean time to tolerate oral diet (measured from surgery). C Box plot comparing the time to defecation (measured from surgery). Abbreviations: ANOVA = one-way analysis of variance; B = butorphanol; F = fentanyl; O = oxycodone

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