Comparative study of hemodynamic effects of intrathecal bupivacaine with butorphanol in cardiac and non-cardiac patients

Abstract

Background and Aims: The synergism between intrathecal opioids and low dose local anesthetics makes it possible to achieve reliable spinal anesthesia (SA) with minimal hypotension. The study objective was to compare the hemodynamic effects of reduced dose of 0.5% intrathecal bupivacaine (2mL) with 25 μg butorphanol in cardiac vs non-cardiac patients. Material and Methods: We included sixty patients aged 30-80 years, undergoing infraumbilical surgeries in the study and compared thirty cardiac patients with mild to moderate reduction in left ventricular ejection fraction (LVEF) on 2D echocardiography (Group C) with 30 non-cardiac patients (Group NC) for similar types of surgery. Both the groups received 0.5% bupivacaine 2.0 ml with 25 μg butorphanol. Results: The spinal block characteristics were similar in both groups ( P > 0.05). The blood pressure of the patients in the two groups was comparable till 80 min P > 0.05 after which Group NC had significant increase in blood pressure compared to Group C upto 95 min ( P < 0.05). Similarly, heart rate was comparable until 90 min ( P > 0.05) after which Group NC had significant increase in heart rate versus Group C upto 100 min ( P < 0.05). Eight patients in group C and five patients in group NC showed hypotension. Bradycardia was seen in 4 patients in group C in comparison to only one patient in group NC. Conclusion: We can safely consider spinal anesthesia with 10 mg bupivacaine and 25μg butorphanol in cardiac patients with mild to moderately reduced ejection fraction presenting for infraumbilical non-cardiac surgeries with the advantage of intraoperative hemodynamic stability and adequate postoperative analgesia.

Advances in the Use of Butorphanol Tartrate in Postoperative Analgesia after Cesarean Section

“…When administered intrathecally, butorphanol tartrate is used as an adjuvant in combination with local anaesthetics to provide satisfactory analgesia, reduce the adverse effects of local anaesthetic drugs, and prolong the duration of postoperative analgesia [24] . Intrathecal local anaesthetics interfere with afferent and efferent sensory and motor impulse conduction by inhibiting voltage-gated sodium channels in the spinal cord, whereas intrathecal injection of butorphanol activates opioid receptors in the dorsal grey matter of the spinal cord and blocks calcium channels to regulate the function of afferent pain fibres, producing a synergistic effect when the two are used in combination, i.e., local anaesthetic drugs blocking the Na+ channels and butorphanol blocking Ca+ channels, which improves both the analgesic quality, as well as reducing sympathetic inhibition and obtaining more stable haemodynamics, which is very beneficial for cardiac patients undergoing non-cardiac surgery [25,26] . At the same time, intrathecal injection of Butorphanol combined with local anaesthetic drugs can also reduce the intensity of motor block, which is conducive to the early walking of patients, and can reduce the occurrence of itching and other complications [27] .…”