AUTHOR=Wen Qiannan , Sun Defeng , Yang Lin , Li Yuexian 

TITLE=Impact of butorphanol versus sufentanil on postoperative cognition and inflammation in elderly: a pilot study

JOURNAL=Frontiers in Aging Neuroscience

VOLUME=Volume 16 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/aging-neuroscience/articles/10.3389/fnagi.2024.1395725

DOI=10.3389/fnagi.2024.1395725

ISSN=1663-4365

ABSTRACT=<sec id="sec1"><title>Background</title><p>This randomized controlled trial aimed to compare the effects of butorphanol and sufentanil on early post-operative cognitive dysfunction (POCD) and systemic inflammation in older surgical patients.</p></sec><sec id="sec2"><title>Methods</title><p>Patients (aged 65 years or above) undergoing surgeries with general anesthesia were randomized to either the butorphanol group (40 μg/kg during anesthesia induction) or the sufentanil group (0.4 μg/kg). Cognitive function changes during the perioperative period were assessed using the Mini-Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA) scale up to 3 days after surgery. POCD was defined as a <italic>Z</italic>-score or composite <italic>Z</italic>-score greater than 1.96 for both MMSE and MoCA scores. Circulating inflammatory factors, including tumor necrosis factor-alpha (TNF-α), interleukin 1 beta (IL-1β), and interleukin 10 (IL-10), were measured using enzyme-linked immunosorbent assay.</p></sec><sec id="sec3"><title>Results</title><p>The study included 114 patients (median age: 71 years, 57.7% male). Compared to sufentanil, butorphanol significantly reduced the incidence of POCD on the first (11.5% versus 32.7%, <italic>p</italic> = 0.017) and third day (3.8% versus 15.4%, <italic>p</italic> = 0.046) after surgery. Additionally, patients receiving butorphanol had significantly lower circulating levels of TNF-α and IL-1β at the time of discharge from the post-anesthesia care unit and on the first and third day after surgery (<italic>p</italic> &lt; 0.05 for all comparisons). Furthermore, circulating IL-10 levels were significantly higher in patients receiving butorphanol (<italic>p</italic> &lt; 0.05 for all comparisons).</p></sec><sec id="sec4"><title>Conclusion</title><p>Administration of butorphanol during anesthesia induction, as opposed to sufentanil, was associated with a significant reduction in the early incidence of POCD in older surgical patients, possibly attributed to its impact on systemic inflammation.</p><p><bold>Clinical trial registration:</bold> The present study was registered in the China Clinical Trial Center (ChiCTR2300070805, 24/04/2023).</p></sec>