Perioperative Butorphanol for the Prevention of Postoperative Pulmonary Complications After Thoracoscopic Lung Resection: A Randomized, Double-Blind, Placebo-Controlled Trial

Postoperative pulmonary complications (PPCs) remain common after thoracoscopic lung resection. Butorphanol, a κ-opioid receptor agonist with analgesic and potential opioid-sparing properties, may influence postoperative respiratory recovery. This trial evaluated whether perioperative butorphanol reduces PPCs after elective thoracoscopic lung resection.

In this randomized, double-blind, placebo-controlled trial conducted at a tertiary teaching hospital in China from January to July 2025, adults aged 18-65 years with American Society of Anesthesiologists physical status I-III scheduled for elective thoracoscopic lung resection were assigned to receive butorphanol or placebo. The butorphanol group received an intravenous bolus of 10 μg/kg before anesthesia induction followed by 5 μg/kg/h until the end of surgery. The control group received volume-matched saline. The primary outcome was PPCs within 7 postoperative days.

Of 520 randomized patients, 506 were included in the modified intention-to-treat analysis. PPCs occurred in 54 of 254 patients (21.3%) in the butorphanol group and 83 of 252 patients (32.9%) in the control group (relative risk, 0.65; 95% CI, 0.48-0.87; P = 0.004), corresponding to an absolute risk reduction of 11.7% and a number needed to treat of 9. The difference was mainly driven by lower rates of atelectasis and pleural effusion. Butorphanol was also associated with higher QoR-40 scores at 24 h, lower opioid consumption, and a modestly shorter hospital stay. Safety outcomes were similar between groups.

Perioperative butorphanol reduced composite PPCs within 7 days after elective thoracoscopic lung resection, mainly through reductions in atelectasis and pleural effusion, without increasing early safety events.