Article (Scientific journals)
Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation.
Timmermans, Carl C.M.M.; Rodriguez, Luz Maria; Ayers, Gregory M. et al.
1999In Circulation, 99 (14), p. 1837-42
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Keywords :
Administration, Intranasal; Adult; Aged; Analgesics, Opioid/administration & dosage/therapeutic use; Atrial Fibrillation/therapy; Butorphanol/administration & dosage/therapeutic use; Double-Blind Method; Electric Countershock/adverse effects; Fear/drug effects; Female; Humans; Hypnotics and Sedatives/administration & dosage/therapeutic use; Injections, Intravenous; Male; Midazolam/therapeutic use; Middle Aged; Pain/drug therapy/etiology/psychology; Treatment Outcome
Abstract :
[en] 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.
Disciplines :
General & internal medicine
Author, co-author :
Timmermans, Carl C.M.M.;  Maastricht University
Rodriguez, Luz Maria;  University Hospital Maastricht
Ayers, Gregory M.
Lambert, Hendrik
Smeets, Joep L.R.M.
Vlaeyen, Johan W. S.
Albert, Adelin  ;  Université de Liège - ULiège > Département des sciences de la santé publique > Informatique médicale et biostatistique
Wellens, Hein J.J.
Language :
English
Title :
Effect of butorphanol tartrate on shock-related discomfort during internal atrial defibrillation.
Publication date :
1999
Journal title :
Circulation
ISSN :
0009-7322
eISSN :
1524-4539
Publisher :
Lippincott Williams & Wilkins, Hagerstown, United States - Maryland
Volume :
99
Issue :
14
Pages :
1837-42
Peer reviewed :
Peer Reviewed verified by ORBi
Available on ORBi :
since 21 January 2013

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