We assessed the effectiveness and tolerability of butorphanol as part of a multimodal analgesic approach together with dexmedetomidine and ketorolac administered via patient-controlled intravenous analgesia (PCIA) following hepatobiliary procedures, using sufentanil as the comparator. Follow-up information after surgery was gathered retrospectively for individuals who underwent hepatobiliary operations at Henan Provincial People’s Hospital from March 2018 through June 2021. Cases were assigned to either a butorphanol-based regimen (group B) or a sufentanil-based regimen (group S), depending on the intravenous controlled analgesia protocol received postoperatively. Propensity score matching (PSM) was applied to balance baseline variables and operative characteristics between the two cohorts. Initial screening identified 3437 patients; after PSM, the matched sample comprised 1816 individuals, with 908 allocated to the butorphanol cohort and 908 to the sufentanil cohort. Relative to group S, group B exhibited a reduced rate of moderate-to-severe pain on both the first day after surgery and the second day after surgery, whether assessed during rest (3.2% vs 10.9%, P < 0.001; 1.2% vs 4.6%, P < 0.001) or during activity (7.0% vs 18.9%, P < 0.001; 2.6% vs 8.7%, P < 0.001). Those administered butorphanol required a smaller amount of morphine (50 mg vs 120 mg, P < 0.001). The frequency of bolus demands on the analgesic pump was notably lower in group B compared with group S (1 vs 2, P < 0.001). The duration of postoperative hospitalization was shorter in group B (11d vs 12d, P = 0.017). The proportion of patients who developed vomiting after surgery was also lower in group B (1.4% vs 3.0%, P = 0.025) than in group S. Conversely, dizziness was encountered more often in group B (0.9% vs 0.1%, P = 0.019). In contrast to sufentanil, incorporating butorphanol into multimodal analgesia coupled with dexmedetomidine and ketorolac through PCIA improved postoperative pain control following hepatobiliary surgery, was associated with a decrease in opioid use, and led to a reduction in postoperative length of hospital stay.
