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Anesthesia and analgesia in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
The agonists/antagonists nalbuphine and butorphanol have also been widely used in many institutions for labor analgesia. These drugs act primarily at the kappa receptor and more weakly at the mu receptor (18). Their advantage over pure opiates is a ceiling effect on respiratory depression. When compared with meperidine, nalbuphine causes less maternal nausea and vomiting, but lower neonatal neurobehavioral scores at 2 to 4 hours of age (26). Butorphanol, when compared with meperidine, affords similar degrees of pain relief (27). Like nalbuphine, there is less maternal nausea and vomiting compared with meperidine. Fetal and neonatal effects are similar when comparing butorphanol and meperidine (28).
Drugs Affecting the Musculoskeletal System
Published in Radhwan Nidal Al-Zidan, Drugs in Pregnancy, 2020
Risk Summary: It should be used with caution during the 1st and 2nd Trimesters. However, it is better to avoid the use of Butorphanol during labor because there is a risk of transient neonatal depression and a sinusoidal fetal heart rate pattern.
Trigeminal autonomic cephalgias I – cluster headache: diagnosis and treatment
Published in Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby, Headache in Clinical Practice, 2018
Stephen D. Silberstein, Richard B. Upton, Peter J. Goadsby
Non-parenteral analgesics and narcotics have little role in the treatment of cluster headache, although they may be useful for some patients who are unresponsive to oxygen and have ischemic heart disease. The opiate butorphanol can be administered by a nasal spray and is sometimes a useful strategy although controlled studies are not available. Caution to avoid overuse syndromes is required. This compound is a sedative as well as an analgesic; this can be a useful combination for patients who have attacks of cluster headache that awaken them from sleep, and, in that setting, could be a very useful option. It has no cardiovascular risks and is thus a medically safe option in patients for whom vasoconstrictor compounds are contraindicated or oxygen has failed to be useful.
Successful conversion from butorphanol nasal spray to buprenorphine/naloxone using a low-dose regimen to assist with opioid tapering in the setting of chronic pain and migraine management in an older adult patient: A case report
Published in Canadian Journal of Pain, 2022
Joshua MacAusland-Berg, Amy Wiebe, Radhika Marwah, Katelyn Halpape
Butorphanol is a mixed agonist–antagonist opioid that was approved by the U.S. Food and Drug Administration in 1991 in a nasal spray formulation for short-term treatment of severe pain.6 However, it was later marketed for migraine treatment despite a paucity of evidence for this indication.6 Butorphanol was initially proposed to have less psychotomimetic effects and reduced abuse potential compared to other opioids; however, postmarketing surveillance data identified drastic increases in addiction-related adverse effects up to 24%.6,7 In 2013, the Canadian Headache Society strongly recommended against the use of butorphanol for migraines due to the risk of adverse effects, dependence, and medication overuse headaches; lack of evidence of benefit compared to other agents; and potential for withdrawal upon discontinuation.7,8 Unfortunately, this recommendation came after many patients had been started on butorphanol and possibly developed dependence, creating a need for strategies to safely transition patients off butorphanol.
An Investigation of a Novel Tendon Transfer Surgery for High Median-Ulnar Nerve Palsy in a Chicken Model
Published in Journal of Investigative Surgery, 2019
Geoffrey R. Browning, Anthony H. Le, Jennifer J. Warnock, Ravi Balasubramanian
Animals in the sham and implant groups were fasted overnight prior to anesthesia. Each chicken was premedicated with butorphanol (1 mg/kg) intramuscularly in the pectoral muscle and placed in a quiet, dark holding area for ten minutes. Level of sedation ranged from none to mild. Each animal was induced in sternal recumbency with isoflurane (2%) via facemask until working anesthetic depth was achieved. The animal was intubated with a 4.0-5.0 mm Cole endotracheal tube. Animals were maintained on isoflurane (1.2-2.5%). Temperature, respiratory rate, heart rate, end tidal carbon dioxide, pulse oximetry, and electrocardiography were monitored throughout the procedure. Enrofloxacin (6 mg/kg) was administered intramuscularly in the pectoral musculature following induction. Butorphanol (1 mg/kg) was given intramuscularly at the end of each surgical procedure. Animals were placed in sternal recumbency after discontinuing isoflurane for recovery and extubated once they had regained laryngeal function and control of their head. Each animal was given access to feed and water once they could stand.
Safety considerations when using drugs to treat pruritus
Published in Expert Opinion on Drug Safety, 2020
Kayla Fourzali, Gil Yosipovitch
In contrast to the pruritic effect of activating mu-opioid receptors, the activation of kappa-opioid receptors inhibits pruritus. Butorphanol is a kappa-opioid agonist with some mu-opioid antagonism that has shown efficacy via intranasal administration (1 mg or 1 spray in the nostril per day) to reduce itch due to various etiologies [54,55]. Butorphanol and other medications of this class, such as nalbuphine which is in clinical trials and nalfurafine that is available only in Japan, are expected to have very limited potential for abuse due to their selective activation of kappa-opioid receptors and mu-opioid antagonism [56]. The most common adverse effects reported include dizziness, somnolence, nausea, and vomiting with withdrawal symptoms uncommonly reported [54,56].