Introduction:To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries.Aims:To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine.Materials and Methods:A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's t-test using IBM SPSS software version 20. P ≤0.05 was considered to be statistically significant. P ≤ 0.001 was considered to be statistically highly significant.Results:Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group.Conclusions:Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients.

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Etoricoxib comes under the class Non-steroidal anti-inflammatory drugs (NSAIDS). It is a selective Cyclooxygenenase-2 enzyme inhibitor which is used mainly for its analgesic effects. Although it is highly efficacious in pain management, the safety profile of COX-2 inhibitor is yet not established in a broader sense. A patient admitted to the medicine ward of a tertiary care hospital with complaints of skin rashes over the face, trunk and extremities. The detailed history of present illness and past medical /medication history revealed the use of Etoricoxib by the patient for the past one month to treat his Rheumatoid Arthritis. it was suspected that the allergic reaction was caused due to the use of Etoricoxib. The suspected drug Etoricoxib was immediately stopped and the patient was managed symptomatically. The Naranjo scale was used to assess the causality of reaction and a score of 7 was obtained, indicating there was a "probable" causal relationship between the suspected drug and the reaction. Severity of the reaction was assessed using Hartwig's severity assessment scale and found out to be a "moderately" severe adverse reaction.