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Effect of Butorphanol Tartrate on Shock-Related Discomfort During Internal Atrial Defibrillation

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Bibliographic Details
Title: Effect of Butorphanol Tartrate on Shock-Related Discomfort During Internal Atrial Defibrillation
Authors: Timmermans, Carl C.M.M., Rodriguez, Luz Maria, Ayers, Gregory M., Lambert, Hendrik, Smeets, Joep L.R.M., Vlaeyen, Johan W. S., Albert, Adelin, Wellens, Hein J.J.
Source: Professor Hein J.J. Wellens: 33 Years of Cardiology and Arrhythmology ISBN: 9780792362098
Publisher Information: Ovid Technologies (Wolters Kluwer Health), 1999.
Publication Year: 1999
Subject Terms: Adult, Male, Midazolam, Electric Countershock, Pain, Pain/drug therapy/etiology/psychology, Atrial Fibrillation/therapy, Sciences de la santé humaine, 03 medical and health sciences, 0302 clinical medicine, Double-Blind Method, Hypnotics and Sedatives/administration & dosage/therapeutic use, Atrial Fibrillation, Humans, Hypnotics and Sedatives, Human health sciences, Administration, Intranasal, Aged, Analgesics, Opioid/administration & dosage/therapeutic use, Butorphanol/administration & dosage/therapeutic use, Fear, Middle Aged, 3. Good health, Analgesics, Opioid, Midazolam/therapeutic use, Treatment Outcome, Butorphanol, Injections, Intravenous, Fear/drug effects, Female, Electric Countershock/adverse effects, General & internal medicine, Médecine générale & interne
Description: Background —In patients with atrial fibrillation, intracardiac atrial defibrillation causes discomfort. An easily applicable, short-acting analgesic and anxiolytic drug would increase acceptability of this new treatment mode. Methods and Results —In a double-blind, placebo-controlled manner, the effect of intranasal butorphanol, an opioid, was evaluated in 47 patients with the use of a step-up internal atrial defibrillation protocol (stage I). On request, additional butorphanol was administered and the step-up protocol continued (stage II). Thereafter, if necessary, patients were intravenously sedated (stage III). After each shock, the McGill Pain Questionnaire was used to obtain a sensory (S), affective (A), evaluative (E), and total (T) pain rating index (PRI) and a visual analogue scale analyzing pain (VAS-P) and fear (VAS-F). For every patient, the slope of each pain or fear parameter against the shock number was calculated and individual slopes were averaged for the placebo and butorphanol group. All patients were cardioverted at a mean threshold of 4.4±3.3 J. Comparing both patient groups for stage II, the mean slopes for PRI-T ( P =0.0099), PRI-S ( P =0.019), and PRI-E ( P =0.015) became significantly lower in the butorphanol group than in the placebo group. Comparing patients who received the same shock intensity ending stage I and going to stage II, in those patients randomized to placebo the mean VAS-P ( P =0.023), PRI-T ( P =0.029), PRI-S ( P =0.030), and PRI-E ( P =0.023) became significantly lower after butorphanol administration. Conclusions —During a step-up internal atrial defibrillation protocol, intranasal butorphanol decreased or stabilized the value of several pain variables and did not affect fear. Of the 3 qualitative components of pain, only the affective component was not influenced by butorphanol. The PRI evaluated pain more accurately than the VAS.
Document Type: Article
Part of book or chapter of book
Language: English
ISSN: 1524-4539
0009-7322
DOI: 10.1161/01.cir.99.14.1837
DOI: 10.1007/978-94-011-4110-9_63
Access URL: http://circ.ahajournals.org/content/99/14/1837.full.pdf
https://pubmed.ncbi.nlm.nih.gov/10199880
https://link.springer.com/10.1007/978-94-011-4110-9_63
https://orbi.uliege.be/handle/2268/139812
https://rd.springer.com/chapter/10.1007/978-94-011-4110-9_63
http://europepmc.org/abstract/MED/10199880
https://link.springer.com/chapter/10.1007%2F978-94-011-4110-9_63
https://www.ahajournals.org/doi/10.1161/01.CIR.99.14.1837
Accession Number: edsair.doi.dedup.....50da220eb4d6803db26bdaa3ab4e95b3
Database: OpenAIRE
Description
Abstract:Background —In patients with atrial fibrillation, intracardiac atrial defibrillation causes discomfort. An easily applicable, short-acting analgesic and anxiolytic drug would increase acceptability of this new treatment mode. Methods and Results —In a double-blind, placebo-controlled manner, the effect of intranasal butorphanol, an opioid, was evaluated in 47 patients with the use of a step-up internal atrial defibrillation protocol (stage I). On request, additional butorphanol was administered and the step-up protocol continued (stage II). Thereafter, if necessary, patients were intravenously sedated (stage III). After each shock, the McGill Pain Questionnaire was used to obtain a sensory (S), affective (A), evaluative (E), and total (T) pain rating index (PRI) and a visual analogue scale analyzing pain (VAS-P) and fear (VAS-F). For every patient, the slope of each pain or fear parameter against the shock number was calculated and individual slopes were averaged for the placebo and butorphanol group. All patients were cardioverted at a mean threshold of 4.4±3.3 J. Comparing both patient groups for stage II, the mean slopes for PRI-T ( P =0.0099), PRI-S ( P =0.019), and PRI-E ( P =0.015) became significantly lower in the butorphanol group than in the placebo group. Comparing patients who received the same shock intensity ending stage I and going to stage II, in those patients randomized to placebo the mean VAS-P ( P =0.023), PRI-T ( P =0.029), PRI-S ( P =0.030), and PRI-E ( P =0.023) became significantly lower after butorphanol administration. Conclusions —During a step-up internal atrial defibrillation protocol, intranasal butorphanol decreased or stabilized the value of several pain variables and did not affect fear. Of the 3 qualitative components of pain, only the affective component was not influenced by butorphanol. The PRI evaluated pain more accurately than the VAS.
ISSN:15244539
00097322
DOI:10.1161/01.cir.99.14.1837