Use of pre-operative anxiety score to determine the precise dose of butorphanol for intra-operative sedation under regional anesthesia: A double-blinded randomized trial

Bijia Song, Yanchao Yang, Xiufei Teng, Yang Li, Wenya Bai, Junchao Zhu, Bijia Song, Yanchao Yang, Xiufei Teng, Yang Li, Wenya Bai, Junchao Zhu

Abstract

A randomized double-blinded controlled trial was performed to explore the association between pre-operative anxiety and intra-operative butorphanol requirement to evaluate the precise sedative requirement and to confirm the sedative effect of butorphanol in patients receiving lower-limb orthopedic surgery. The Amsterdam pre-operative anxiety and information scale and the Ramsay sedation score (RSS) were used to assess the patients' pre-operative anxiety score and sedation state during surgery. Patients were divided into two groups according to their pre-operative anxiety score prior to administration of pre-medication. Patients in each group were randomly divided into a butorphanol group and a 0.9% saline group. A total of 142 patients were enrolled and 131 patients were analyzed. The sedation scores of patients with high pre-operative anxiety in the 0.9% saline group were lower than those in the butorphanol group at each time-point after infusion. An increased pre-operative anxiety score predicted an increased duration to reach an RSS of 4 for an acceptable level of sedation (r2=0.887, P<0.0001). In conclusion, butorphanol had a good sedative effect on patients with pre-operative anxiety. The following formula was proposed: Precise dose of butorphanol (µg/kg)=15.26 + (0.14× pre-operative anxiety score), which may provide an improvement for patients exhibiting a high level of pre-operative anxiety. The trial was registered prior to patient enrollment at clinicaltrials.gov on 20.01.2018 (trial registration no. NCT03429179).

Keywords: butorphanol; intra-operative sedation; pre-operative anxiety; precise dose.

Copyright: © Song et al.

Figures

Figure 1.
Figure 1.
Flow diagram for the inclusion of patients in the present study. RSS, Ramsay Sedation Score.
Figure 2.
Figure 2.
Timeline of the experimental procedure. RSS, Ramsay Sedation Score; VAS, visual analogue scale; APAIS, Amsterdam pre-operative anxiety and information scale.
Figure 3.
Figure 3.
Association between the APAIS score of patients and the duration of the Ramsay sedation score reaching 4 (min). APAIS, Amsterdam pre-operative anxiety and information scale.

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