A COMPARATIVE STUDY OF THE EFFECT OF EPIDURAL BUPIVACAINE (0.125%) VERSUS EPIDURAL BUPIVACAINE (0.125%) AND BUTORPHANOL (2mg) FOR POST-OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES

Abstract

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.

A Comparative Study of Epidural Bupivacaine and Epidural Bupivacaine With Lowdose Butorphanol for Perioperative Analgesia in Patients Undergoing Elective Gynaecological Surgeries

“…Chaithanya K et al 25 Butorphanol (2 mg) was reported to achieve better quality of pain relief (lower VAS scores) and less nauseavomiting and slightly more sedation compared with tramadol (100 mg). Although, both butorphanol (2 mg) and tramadol (100 mg) as epidural adjuvant were effective for prolonging postoperative analgesia, a shorter duration of analgesia was noticed with butorphanol compared with tramadol; 5.35 ± 0.29 versus 6.25 ± 0.1.58 hours, respectively.…”

Comparative Evaluation of Tramadol and Fentanyl for Epidural Analgesia in Lower Limb Surgeries

“…Tramadolanditsmajormetabolitesareagonistatkappaopioidreceptorsandmixedagonist-antagonistsatmuopioid receptors. [3] Fentanyl, a highly lipid soluble, pure mu agonist with rapid onset and short duration of action has been used with various local anaesthetics for wide variety of surgicalprocedures.Fentanylishighlylipophilic,rapidlydiffusesout of epidural space and much of fentanyl analgesic effect is mediatedbysystemicabsorptionratherthanspinalreceptor binding. These highly lipid soluble agents as fentanyl are associated with rapid dermatomal spread, rapid onset and lowincidenceofpruritisornauseaandcanbepotentiatedby epinephrine.…”