Wang Weilian, Zhang Chang, Zhou Qian, Dan Jiapeng, Zhang Kun, Zheng Ting
Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fuzhou, Fujian, China.
Department of Anesthesiology, Jingzhou Central Hospital, Jingzhou Hospital Affiliated to Yangtze University, Jingzhou, Hubei, China.
Ann Med. 2025 Dec;57(1):2534853. doi: 10.1080/07853890.2025.2534853. Epub 2025 Jul 25.
Opioid receptor agonist/antagonists have positive effects in the management of catheter-related bladder discomfort (CRBD). Whether the differences in κ receptor affinity will have different effects is still unknown. This study aims to compare the efficacy of opioid agents with varying κ receptor affinity profiles in alleviating CRBD and emergence agitation (EA).
A total of 120 patients undergoing open spinal surgery were randomly assigned into three groups: saline group, butorphanol group, and nalbuphine group. All drugs were injected intravenously 30 min before the end of surgery. The primary outcomes were the incidence of moderate to severe CRBD and EA at 5 min after tracheal extubation. Secondary outcomes included the severity of CRBD, numerical rating scales (NRS), Richmond agitation-sedation scale (RASS) at five time points after tracheal extubation, the need for rescue analgesia and the incidence of adverse events were also recorded.
The incidence of moderate to severe CRBD was significantly lower in group B compared to group C ( < 0.001) at all the time points. Group B had significantly fewer patients with severe CRBD and lower NRS scores than both groups C and N ( < 0.001) at T1 and T2. Group B had lower RASS scores than groups N and C at T1, while at T2, T3 and T4, groups B and N continued to exhibit significantly lower NRS scores compared to group C ( < 0.001). The requirement for rescue analgesia decreased sequentially from group C to group N and then to group B ( < 0.001). The incidence of EA was significantly lower in groups B and N than in group C ( < 0.001).
Opioid receptor agonist/antagonists demonstrate efficacy in preventing CRBD and EA without significant adverse events. Butorphanol exhibits superior efficacy to nalbuphine in the early postoperative period.
阿片受体激动剂/拮抗剂在导管相关性膀胱不适（CRBD）的管理中具有积极作用。κ受体亲和力的差异是否会产生不同影响尚不清楚。本研究旨在比较具有不同κ受体亲和力谱的阿片类药物在缓解CRBD和苏醒期躁动（EA）方面的疗效。
总共120例行开放性脊柱手术的患者被随机分为三组：生理盐水组、布托啡诺组和纳布啡组。所有药物均在手术结束前30分钟静脉注射。主要结局是气管拔管后5分钟时中重度CRBD和EA的发生率。次要结局包括CRBD的严重程度、数字评分量表（NRS）、气管拔管后五个时间点的里士满躁动镇静量表（RASS），还记录了补救镇痛的需求和不良事件的发生率。
在所有时间点，B组中重度CRBD的发生率均显著低于C组（<0.001）。在T1和T2时，B组严重CRBD患者明显少于C组和N组，且NRS评分更低（<0.001）。在T1时，B组的RASS评分低于N组和C组，而在T2、T3和T4时，B组和N组的NRS评分继续显著低于C组（<0.001）。补救镇痛的需求从C组到N组再到B组依次降低（<0.001）。B组和N组的EA发生率显著低于C组（<0.001）。
阿片受体激动剂/拮抗剂在预防CRBD和EA方面显示出疗效，且无明显不良事件。在术后早期，布托啡诺的疗效优于纳布啡。
