Perioperative Butorphanol for the Prevention of Postoperative Pulmonary Complications After Thoracoscopic Lung Resection: A Randomized, Double-Blind, Placebo-Controlled Trial.
Postoperative pulmonary complications (PPCs) remain common after thoracoscopic lung resection. Butorphanol, a κ-opioid receptor agonist with analgesic and potential opioid-sparing properties, may influence postoperative respiratory recovery. This trial evaluated whether perioperative butorphanol reduces PPCs after elective thoracoscopic lung resection.
In this randomized, double-blind, placebo-controlled trial conducted at a tertiary teaching hospital in China from January to July 2025, adults aged 18-65 years with American Society of Anesthesiologists physical status I-III scheduled for elective thoracoscopic lung resection were assigned to receive butorphanol or placebo. The butorphanol group received an intravenous bolus of 10 μg/kg before anesthesia induction followed by 5 μg/kg/h until the end of surgery. The control group received volume-matched saline. The primary outcome was PPCs within 7 postoperative days.
Of 520 randomized patients, 506 were included in the modified intention-to-treat analysis. PPCs occurred in 54 of 254 patients (21.3%) in the butorphanol group and 83 of 252 patients (32.9%) in the control group (relative risk, 0.65; 95% CI, 0.48-0.87; P = 0.004), corresponding to an absolute risk reduction of 11.7% and a number needed to treat of 9. The difference was mainly driven by lower rates of atelectasis and pleural effusion. Butorphanol was also associated with higher QoR-40 scores at 24 h, lower opioid consumption, and a modestly shorter hospital stay. Safety outcomes were similar between groups.
Perioperative butorphanol reduced composite PPCs within 7 days after elective thoracoscopic lung resection, mainly through reductions in atelectasis and pleural effusion, without increasing early safety events.
In this randomized, double-blind, placebo-controlled trial conducted at a tertiary teaching hospital in China from January to July 2025, adults aged 18-65 years with American Society of Anesthesiologists physical status I-III scheduled for elective thoracoscopic lung resection were assigned to receive butorphanol or placebo. The butorphanol group received an intravenous bolus of 10 μg/kg before anesthesia induction followed by 5 μg/kg/h until the end of surgery. The control group received volume-matched saline. The primary outcome was PPCs within 7 postoperative days.
Of 520 randomized patients, 506 were included in the modified intention-to-treat analysis. PPCs occurred in 54 of 254 patients (21.3%) in the butorphanol group and 83 of 252 patients (32.9%) in the control group (relative risk, 0.65; 95% CI, 0.48-0.87; P = 0.004), corresponding to an absolute risk reduction of 11.7% and a number needed to treat of 9. The difference was mainly driven by lower rates of atelectasis and pleural effusion. Butorphanol was also associated with higher QoR-40 scores at 24 h, lower opioid consumption, and a modestly shorter hospital stay. Safety outcomes were similar between groups.
Perioperative butorphanol reduced composite PPCs within 7 days after elective thoracoscopic lung resection, mainly through reductions in atelectasis and pleural effusion, without increasing early safety events.
Authors
Wang Wang, Zhang Zhang, Wu Wu, Yin Yin, Xia Xia, Zhao Zhao, Zeng Zeng, Wu Wu, Sun Sun, Liu Liu
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