BACKGROUND: Postoperative pain gives rise to various physiological and psychological phenomenons. Epidural analgesia with combination of local anesthetics and opioids provides better pain relief than local anesthetics alone in the postoperative period. Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. AIMS: The study was conducted to evaluate the efficacy of addition of opioids to local anesthetics for postoperative pain relief. METHODS: Fifty patients of American society of anesthesiology grade and physical status undergoing lower abdominal surgeries & lower limb surgeries in narayana general hospital, Nellore, were divided into two groups B and BB. Group B was given 0.125% bupivacaine alone and Group BB was given 0.125% bupivacaine plus 2mg of butorphanol postoperatively when the patients first complained of pain. Onset of Analgesia, duration of analgesia, visual analog scores and side effects were compared. RESULTS: The onset of analgesia in group B patients (10ml of 0.125% Bupivacaine) was varied from 4-8 minutes (mean 5.2 minutes) and duration of analgesia lasted for 2-4 hours (mean 2.98)(p<0.0001) where as in group BB patients (2mg butorphanol + 0.125% bupivacaine) the onset was 2-4 minutes (mean 2.69) and duration of analgesia lasted for 6-8 hours (mean 6.98) (p<0.0001).The Visual Analog Scores of Group B were in the range of 7 to 9 and Group BB were in the range of 5 to 6 (P<0.0001). CONCLUSION: This study concludes that addition of butorphanol (2mg) to bupivacaine (0.125%) gives more effective and prolonged duration of postoperative pain relief when administered epidurally, without significant side effects.

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BACKGROUND AND AIMS: Percutaneous nephrolithotomy (PCNL) is a safe and effective endourologic procedure in patients with renal calculi. Though it is less painful than open surgery, effective postoperative analgesia is required to reduce the pain around the nephrostomy site. Objectives of this study are to compare and evaluate the peritubal infiltration of bupivacaine, ropivacaine, and placebo from renal capsule to skin along the nephrostomy tract for postoperative analgesia in percutaneous nephrolithotomy (PCNL). MATERIALS AND METHODS: A randomized controlled double blinded study was designed in 60 American Society of Anesthesiologists (ASA) grade I and II patients to assess & compare the impact of peritubal infiltration of bupivacaine, ropivacaine, saline with 23-gauge spinal needle along the nephrostomy tract after PCNL under fluoroscopic guidance. Patients were randomized into 3 groups B (bupivacaine), R (ropivacaine), S (saline/control). Each group containing 20 patients were given 20mL of respective drug at the conclusion of the procedure. Postoperative pain score and analgesic requirement for the first 24 hours were assessed by visual analog scale second hourly. Rescue analgesia with inj. Tramadol 2mg/kg was given intravenously to a maximum total dose of 400mg when pain score exceeded 4. RESULTS: Pain scores and analgesic requirement for the first 24 hours postoperatively were lesser in the B (bupivacaine) & R(ropivacaine) groups than in the S(saline/control) group of patients at all points of time and were statistically significant (p<0.005). CONCLUSION: In this study a significant difference in the pain scores and analgesic requirement was noted in saline and drug groups. Peritubal infiltration of 0.25% bupivacaine or 0.375% ropivacaine solutions is equally efficient in alleviating postoperative pain after PCNL.