Butorphanol

INTRODUCTION

Indications

Management of moderate to severe pain. Analgesia during labor. Sedation before surgery. Supplement in balanced anesthesia.

Action

Binds to opiate receptors in the CNS. Alters the perception of and response to painful stimuli while producing generalized CNS depression. Has partial antagonist properties that may result in opioid withdrawal in physically dependent patients. Therapeutic Effects: Decreased severity of pain.

Adverse Reactions/Side Effects

CNS: confusion, dysphoria, hallucinations, sedation, euphoria, floating feeling, headache, unusual dreams. EENT: blurred vision, diplopia, miosis (high doses). Resp: respiratory depression. CV: hypertension, hypotension, palpitations. GI: nausea, constipation, dry mouth, ileus, vomiting. GU: urinary retention. Derm: sweating, clammy feeling. Misc: physical dependence, psychologic dependence, tolerance.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess symptoms of respiratory depression, including decreased respiratory rate, confusion, bluish color of the skin and mucous membranes (cyanosis), and difficult, labored breathing (dyspnea). Monitor pulse oximetry and perform pulmonary function tests (See Appendix I) to quantify suspected changes in ventilation and respiratory function. Excessive respiratory depression requires emergency care.

• Be alert for excessive sedation or changes in mood and behavior (euphoria, dysphoria, confusion, hallucinations). Notify physician or nurse immediately if patient is unconscious or extremely difficult to arouse.

• Use appropriate pain scales (visual analogue scales, others) to document whether this drug is successful in helping manage the patient's pain.

• Assess blood pressure (BP) and compare to normal values (See Appendix F). Report changes in BP, either a problematic decrease in BP (hypotension) or a sustained increase in BP (hypertension).

Interventions

• Implement appropriate manual therapy techniques, physical agents, and therapeutic exercises to reduce pain and help wean patient off opioid analgesics as soon as possible.

• Because of the risk of abnormal BP responses, use caution during aerobic exercise and other forms of therapeutic exercise. Assess exercise tolerance frequently (BP, heart rate, fatigue levels), and terminate exercise immediately if any untoward responses occur (See Appendix L).

• Help patient explore other nonpharmacologic methods to reduce chronic pain, such as relaxation techniques, exercise, counseling, and so forth.

• Guard against falls and trauma (hip fractures, head injury). Implement fall-prevention strategies (See Appendix E), especially if patient exhibits sedation, dizziness, or blurred vision.

• To minimize orthostatic hypotension, patient should move slowly when assuming a more upright position.

Patient/Client-Related Instruction

• Advise patient that opioid analgesics are usually more effective if given before pain becomes severe; emphasize that adequate pain control will allow better participation in physical therapy.

• Educate patient about the dangers of opioid overdose; encourage patient to adhere to proper dosing schedule.

• Emphasize ...