Effects of butorphanol combined with ropivacaine on plasma adrenocorticotropic hormone and cortisol levels and postpartum depression in labor analgesia

Abstract

BACKGROUND

Labor pain triggers robust hypothalamic-pituitary-adrenal-axis activation, releasing adrenocorticotropic hormone (ACTH)/cortisol that fuels systemic inflammation and predicts postpartum depression (PPD). Although epidural ropivacaine is standard in China, adding the κ-agonist butorphanol may synergistically block pain and restrain this neuroendocrine stress response, offering a novel strategy to protect maternal mental health.

AIM

To investigate the effects of the combined use of butorphanol and ropivacaine on the plasma levels of ACTH and cortisol in patients undergoing labor analgesia as well as the incidence of PPD. We also compared the incidence of adverse reactions between the two groups. This study aimed to evaluate the regulatory effects of drug combinations and their side effects on the stress response of pregnant women, providing a basis for clinical intervention.

METHODS

Between June 2020 and June 2023, 114 pregnant women were randomly divided into study and control groups, with 57 participants in each group. The research group received a combination therapy of butorphanol and ropivacaine, whereas the control group received a combination therapy of sufentanil and ropivacaine. All participants received combined spinal epidural anesthesia to alleviate delivery pain. The Visual Analog Scale was used to assess the pain levels at different timepoints. We compared the incidence of adverse reactions and evaluated the incidence of PPD in the delivery room at 2 hours, 1 day, and 7 days postpartum using the Edinburgh Postnatal Depression Scale. Venous blood samples were collected using a fully automated chemiluminescence analyzer to measure ACTH and cortisol.

RESULTS

The Visual Analog Scale scores of the study group were significantly lower than those of the control group at all timepoints (P < 0.05). In addition, the Edinburgh Postnatal Depression Scale scores of the study group on days 1 and 7 postpartum were significantly lower than those of the control group (P < 0.05), indicating a lower risk of PPD in the study group. There was no significant difference in 24-hour neonatal behavioral neurological assessment, 1-minute Apgar score, and total treatment cost between the two groups of newborns (P > 0.05), and no respiratory depression was observed. The incidence rates of adverse reactions were 5.26% and 17.54% in the study and control groups, respectively. Two hours after delivery, both groups showed a decreasing trend in ACTH and cortisol; however, the levels in the study group were significantly lower than those in the control group (P < 0.05).

CONCLUSION

The combination of butorphanol and ropivacaine for labor analgesia can significantly reduce pain scores in women and lower the risk of postpartum pain. Additionally, it reduces the incidence of adverse reactions without compromising the safety of both the mother and newborn. This effect may be attributed to the synergistic analgesic effects of the drugs, neuroendocrine regulation, and the improved psychological and physiological conditions of the mother.

Keywords: Butorphanol; Ropivacaine; Labor analgesia; Adrenocorticotropic hormone; Cortisol; Postpartum depression

Core Tip: This study demonstrates that a combination of butorphanol and ropivacaine for labor analgesia significantly reduces pain scores, stress hormone levels (adrenocorticotropic hormone and cortisol), and the incidence of postpartum depression compared to sufentanil-ropivacaine. The combination provides a faster onset of analgesia, fewer adverse reactions, and better neuroendocrine regulation, making it a safer and more effective option for maternal care.