Comparison of two different doses of Epidural Butorphanol in Lower Limb Orthopedic Surgery

Shweta Kujur, Durga Kosam

Abstract


Introduction: Epidural and spinal anaesthesia both are effective alternative to general anaesthesia when surgical site is located in lower extremities. When post operative analgesia is required epidural anaesthesia is the choice. This study was conducted to assess the effect of Butorphanol added to local anaesthetic via epidural route and to optimize the dose of Butorphanol via epidural route i.e. 2mg and 3 mg and to observe the duration of postoperative analgesia with two different doses. Methodology: A randomized control study was conducted on 40 ASA I & II patients of either sex aged 18-60 yrs undergoing lower limb orthopedic surgery under epidural anesthesia. The patients were randomly allocated into two equal groups. Group A received 2 mg of Butorphanol along with local anaesthetic solution and Group B received 3mg of Butorphanol along with local anaesthetic. The onset and peak effect of sensoryand motor block, level of sedation, hemodynamic changes and duration of postoperative analgesia and complications, if any were observed. Results: For sensory effect, onset was 25±7.07 sec and peak effect 312.5±12.4 sec in Group A patients as compared to Group B where it was 12.81±21.68 sec and 162.8±21.68 sec respectively, which is statistically significant (P<0.05). For motor effect onset was 3.5±1.01 min and peak effect 11.4±3.91 min in Group A patients as compared to Group B patients where it was 2.7±0.67 min and 6.09±0.97 min (P<0.05). Hemodynamics remained stable and comparable in both the groups (P>0.05). Duration of postoperative analgesia according to VAS, pain relief in Group A patients was up to 8 hrs and in Group B it was up to 12 hours and rescue analgesia required only after 12hrs (P<0.05). Conclusion: Newer synthetic opioid- Butorphanol can be used along with local anaestheticsolution via epidural route in lower limb surgeries with effective intraoperative sedation and prolonged postoperative analgesia without fear of nausea/vomiting and respiratory depression.

Full Text:

PDF HTML

References


Petropoulos G, Siristatidis C, Salamalekis E, Creatsas G. Spinal and epidural versus general anesthesia for elective cesarean section at term: effect on theacid-base status of the mother and newborn. J Matern Fetal Neonatal Med. 2003 Apr;13(4):260-6. DOI:10.1080/jmf. 13.4.260.266.

Palacios QT, Jones MM, Hawkins JL, et al. Post-caesarean section analgesia: a comparison of epidural butorphanol and morphine. Can J Anaesth. 1991 Jan; 38(1):24-30. DOI:10.1007/BF03009159.

Graham AC, McClure JH. Quantitative assessment of motor block in labouring women receiving epidural analgesia. Anaesthesia. 2001 May;56(5):470-6.

Kaur J, Bajwa SJ. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study. Saudi J Anaesth. 2014 Apr; 8(2):167-71. doi: 10.4103/1658-354X.130687.

Del Pizzo A. A double-blind study on the effects of butorphanol compared with morphine in balanced anaesthesia. Can Anaesth Soc J. 1978 Sep;25(5):392-7.

Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth. 1997 May;78(5):606-17.

Rosenberg J, Kehlet H. [Surgical physiopathology. New results of importance for optimization of the postoperative course]. UgeskrLaeger. 2001 Feb 12;163 (7): 908-12.

Zacny JP, Lichtor JL, Thapar P, et al. Comparing the subjective, psychomotor and physiological effects of

intravenous butorphanol and morphine in healthy volunteers. J Pharmacol Exp Ther. 1994 Aug;270(2): 579-88.

Gupta R, Kaur S, Singh S, Aujla KS. A comparison of Epidural Butorphanol and Tramadol for Post-operative Analgesia Using CSEA Technique. J Anaesthesiol Clin Pharmacol. 2011 Jan;27(1):35-8.

Clotz MA, Nahata MC. Clinical uses of fentanyl, sufentanil, and alfentanil. Clin Pharm. 1991 Aug;10 (8):581-93.

Saxena AK, Arava SK. Current concepts in neuraxial administration of opioids and non opioids: An overview and future perspectives.Indian J Anaesth. 2004 Feb; 48(1): 13-24.

Parikh GP, Veena SR, Vora K, et al. Comparison of epidural butorphanol versus epidural morphine in postoperative pain relief. Middle East J Anaesthesiol. 2014 Feb;22(4):371-6.

Abboud TK, Moore M, Zhu J, et al. Epidural butorphanol or morphine for the relief of post-cesarean section pain: ventilatory responses to carbon dioxide. AnesthAnalg. 1987 Sep;66(9):887-93.

Heel RC, Brogden RN, Speight TM, Avery GS. Butorphanol: a review of its pharmacological properties and therapeutic efficacy. DOI:10.2165/00003495-19781 6060-00001.

Gunter JB, McAuliffe J, Gregg T, et al. Continuous epidural butorphanol relieves pruritus associated with epidural morphine infusions in children. Paediatr Anaesth. 2000;10(2):167-72.


Refbacks

  • There are currently no refbacks.