Comparative study of intrathecal bupivacaine 0.5% with bupivacaine 0.5% and buprenorphine low dose for postoperative analgesia in lower abdominal surgeries

Abstract

INTRODUCTIONPain is one of the most common and uncomfortable consequences of a surgery, feared by all. Effective and rapid relief from pain is always a challenge, but is necessary for alleviating nocioception -induced responses like endocrine metabolic responses to surgery, autonomic reflexes with adverse effects on organ function, reflexes leading to muscle spasm, and other undesirable results. 1 ABSTRACT Background: Opiods, like buprenorphine, have been widely used for providing pain relief postoperatively and their advantages of neuraxial narcotics over systemic narcotics are well established. When compared to local anaesthetics, they offer good analgesia while allowing early ambulation of the patient by sparing sympathetic and motor nerves. This study was conducted to compare the efficacy of bupivacaine alone and in combination with low dosage of buprenorphine. Methods: 80 patients between the ages 20-60 undergoing lower abdominal surgeries were divided into 2 groups of 40 each after taking detailed history and undergoing the necessary preliminary tests. Patients in the Group I was given 17.5mg of 0.5% Hyperbaric Bupivacaine along with 60ug of Buprenorphine. The patients in Group II received 17.5mg of 0.5% Hyperbaric Bupivacaine. Onset and duration of analgesia were recorded. The efficacy of analgesia was recorded based on VAS score. Side effects, time of recovery also were noted. Results: In this retrospective study we found that incidence of colorectal carcinoma is more between 40-60 years of age with male predominance; lymph node metastasis is more than metastasis in any other sites. CT scan can diagnose lymphatic metastasis and infiltration in surrounding tissue more accurately. Percentage of sphincter saving procedure was low in rectal malignancies in our study. Conclusions: The onset of analgesia was within 5 minutes in 100% of the cases in Group I while in Group II it was upto 9 minutes. The mean of the duration of analgesia was 15h 33mins and 3 h 18 mins in Group I and II respectively. The pain scoring through VAS in the 2 groups showed that most of the patients in Group I had 0 to mild pain till about 12 hours while in Group II the analgesic effect was felt only till the first 2 hours. The supplementary analgesic was required on Group II within 4 hours post operatively while in Group I the requirement was only after 12 hours. The major side effect among the patients was vomiting and nausea in 12 patients in Group I followed by urinary retention in 6 patients. While in Group II only 6 patients had nausea and no other side effect. Pruritis was observed in 1 patient in Group I Respiratory distress, drowsiness, headache and backache was not observed in any of the cases.

Effect of Different Doses of Buprenorphine in Combination with Bupivacaine in the Management of Postoperative Analgesia

“…[ 12 14 16 ] Lower or no bradycardia with lower doses of buprenorphine in our study was supported by studies elsewhere. [ 13 15 17 18 19 ] Our observation of a higher incidence of hypotension in higher doses of buprenorphine (150 μg) compared to lower doses was similar to a study by Mishra and Maharana who reported a significant change in mean arterial pressure with higher doses of buprenorphine. [ 16 ] Other studies also supported our findings on incidences of hypotension with different doses of buprenorphine.…”