To investigate the clinical efficacy of butorphanol combined with remimazolam in single-port thoracoscopic lobectomy for non-small cell lung cancer (NSCLC).

A total of 78 patients with NSCLC undergoing lobectomy in our hospital from July 2020 to December 2024 were selected and divided into a control group 41 cases and an observation group 37 cases according to different anesthesia protocols. All patients received an intravenous bolus of butorphanol 30 μg/kg 15 minutes before anesthesia induction. For induction, the control group received intravenous propofol 1.5~2.5 mg/kg, sufentanil 0.2~0.4 μg/kg, and cisatracurium 0.15~0.2 mg/kg; the observation group received intravenous remimazolam 0.2~0.3 mg/kg, sufentanil 0.2~0.4 μg/kg, and cisatracurium 0.15~0.2 mg/kg. For anesthesia maintenance, the control group received continuous intravenous infusion of propofol 5~10 mg/kg/h and remifentanil 0.05~0.2 μg/kg/min, combined with inhalation of 1.7%~2.5% sevoflurane and intermittent intravenous boluses of cisatracurium 0.06~0.12 mg/kg for muscle relaxation. The observation group received continuous intravenous infusion of remimazolam 0.4~1.2 mg/kg/h and remifentanil 0.05~0.2 μg/kg/min, combined with inhalation of 1.7%~2.5% sevoflurane and intermittent intravenous boluses of cisatracurium 0.06~0.12 mg/kg. Surgical parameters, hemodynamics, respiratory function recovery, postoperative analgesia, serum biomarkers, and postoperative complications were compared between the two groups.

The intraoperative remifentanil consumption in the observation group [(1 729.81±181.22) μg vs. (1 854.43±198.95) μg] was lower than that in the control group (P<0.05). At 5 minutes after tracheal intubation (T1), heart rate (HR) [(75.28±6.76) beats/min vs. (69.36±7.38) beats/min] and mean arterial pressure (MAP) [(75.16±6.42) mmHg vs. (69.97±6.68) mmHg] were higher in the observation group than in the control group (P<0.05). At 60 minutes after one-lung ventilation (T2), HR[(75.34±6.87) beats/min vs. (72.49±7.22) beats/min] and MAP [(76.28±6.06) mmHg vs. (73.23±6.03) mmHg] were higher in the observation group than in the control group (P<0.05). At 1 week postoperatively, forced expiratory volume in the first second (FEV₁) [(2.11±0.37) L vs. (1.94±0.33) L], maximum voluntary ventilation (MVV) [(60.87±8.49) L/min vs. (56.84±8.11) L/min], and PaO₂/FiO₂ [(329.34±31.39) vs. (314.59±28.47)] were higher in the observation group than in the control group (P<0.05). Visual analogue scale (VAS) scores at 12 h, 24 h, and 48 h postoperatively [(3.02±0.35) vs. (3.36±0.57); (2.78±0.36) vs. (2.98±0.39); (2.39±0.31) vs. (2.55±0.34)] were lower in the observation group than in the control group (P<0.05). Immediately after surgery, cortisol (Cor) [(289.47±36.72) nmol/L vs. (308.48±35.29) nmol/L] and S100 calcium-binding protein B (S100β) [(1.87±0.43) μmol/L vs. (2.11±0.47) μmol/L] were lower in the observation group than in the control group (P<0.05). At 24 h postoperatively, Cor [(254.65±36.29) nmol/L vs. (274.37±35.14) nmol/L] and S100β [(0.74±0.13) μmol/L vs. (0.81±0.16) μmol/L] were lower in the observation group than in the control group (P<0.05). There was no statistically significant difference in the incidence of postoperative complications between the observation group 6 cases (16.22%) and the control group 7 cases (17.07%)(P>0.05).

Butorphanol combined with remimazolam for single-port thoracoscopic lobectomy in NSCLC patients provides effective analgesia, stabilizes hemodynamics, improves serum biomarker levels, and promotes postoperative recovery of respiratory function, demonstrating clinical significance.