Transnasal butorphanol tartrate for pain control following ambulatory surgery

Abstract

Thirty patients who had undergone laparoscopic Yoon fallopian ring sterilization, laparotomy tubal sterilization, arthroscopy with meniscectomy, inguinal herniorrhaphy, or rectal surgery and who had moderate to severe postsurgical pain were enrolled in an open study conducted in an ambulatory surgical setting. Over a 3-day period after discharge from the surgical unit, patients self-administered transnasal butorphanol tartrate 0.5 mg under a flexible dosage regimen. Before surgery, patients were trained on the proper use of the nasal spray device for administering transnasal butorphanol. At the clinic before discharge, measurements of analgesia and safety were made at specified intervals. At discharge, patients were given a diary to record daily the number and time of drug administration, any adverse experiences, and global assessment of pain relief. At the clinic, 50% relief from baseline pain was achieved for the 30 patients after a mean total dose of 1.07 mg had been administered. The average time to 50% relief was 1 hour after the initial 0.5-mg dose. Of the patients who required analgesia at home, transnasal butorphanol provided satisfactory pain relief for 79% of the patients on day 1, 95% on day 2, and 91% on day 3. Adverse experiences were reported by 70% of the patients on day 1, with dizziness, nausea, and drowsiness, being the most frequent. On day 2, 36% reported such experiences, with headache and dizziness being the most frequent. Of the 11 patients who required medication on day 3, only one reported an adverse experience (sneezing). None of the adverse effects were serious. The results from this study support the usefulness of transnasal butorphanol in an ambulatory surgical setting for the management of pain when the use of an opioid analgesic is appropriate.