Pain and therapy · 2026
Safety and Analgesic Effectiveness of Adding Butorphanol to Multimodal Intravenous Patient-Controlled Analgesia After Gynecologic Surgery: A Retrospective Cohort Study.
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Ye Yingchao, Feng Chengyao, Dong Yangxin, Wu Feixiang, Gong Han, Wu Youmei, Xia Fangfang
Аннотация
INTRODUCTION: Butorphanol is sometimes added to multimodal intravenous patient-controlled analgesia (PCA), but its incremental analgesic benefit and adverse symptom burden when combined with an established sufentanil-based regimen remain uncertain.
METHODS: This single-center retrospective cohort study used routinely collected perioperative, postoperative PCA follow-up, and hospital billing data from July 2022 to June 2025. Patients who underwent gynecologic surgery and received one of four eligible base PCA regimens were included. Movement-evoked pain on postoperative day 1 was the primary effectiveness outcome, and any dizziness was the primary safety outcome. Propensity score overlap weighting was used for the primary analysis.
RESULTS: The cohort included 1557 PCA treatment records, of which 239 contained butorphanol and 1318 did not. After overlap weighting, the adjusted mean differences were 0.01 points [95% confidence interval (CI) - 0.09 to 0.10; P = 0.935] for movement-evoked pain, 0.07 points (95% CI - 0.02 to 0.16; P = 0.139) for resting pain, and - 0.78 mL (95% CI - 3.17 to 1.60; P = 0.539) for PCA volume delivered. Dizziness occurred in 13.6% of butorphanol-containing records and 6.0% of controls [adjusted risk difference 7.7 percentage points, 95% CI 3.3-12.5; odds ratio (OR) 2.49, 95% CI 1.53-4.03; P < 0.001]. Higher odds were also observed for nausea (OR 1.76, 95% CI 1.22-2.47; P = 0.005) and co-occurring dizziness and nausea (OR 5.85, 95% CI 3.10-11.41; P < 0.001).
CONCLUSION: In the measured overlap population, adding butorphanol did not materially improve early analgesic outcomes but was associated with more dizziness and nausea. Residual confounding precludes definitive causal conclusions.
METHODS: This single-center retrospective cohort study used routinely collected perioperative, postoperative PCA follow-up, and hospital billing data from July 2022 to June 2025. Patients who underwent gynecologic surgery and received one of four eligible base PCA regimens were included. Movement-evoked pain on postoperative day 1 was the primary effectiveness outcome, and any dizziness was the primary safety outcome. Propensity score overlap weighting was used for the primary analysis.
RESULTS: The cohort included 1557 PCA treatment records, of which 239 contained butorphanol and 1318 did not. After overlap weighting, the adjusted mean differences were 0.01 points [95% confidence interval (CI) - 0.09 to 0.10; P = 0.935] for movement-evoked pain, 0.07 points (95% CI - 0.02 to 0.16; P = 0.139) for resting pain, and - 0.78 mL (95% CI - 3.17 to 1.60; P = 0.539) for PCA volume delivered. Dizziness occurred in 13.6% of butorphanol-containing records and 6.0% of controls [adjusted risk difference 7.7 percentage points, 95% CI 3.3-12.5; odds ratio (OR) 2.49, 95% CI 1.53-4.03; P < 0.001]. Higher odds were also observed for nausea (OR 1.76, 95% CI 1.22-2.47; P = 0.005) and co-occurring dizziness and nausea (OR 5.85, 95% CI 3.10-11.41; P < 0.001).
CONCLUSION: In the measured overlap population, adding butorphanol did not materially improve early analgesic outcomes but was associated with more dizziness and nausea. Residual confounding precludes definitive causal conclusions.