Assessment of Epidural Butorphanol, Nalbuphine and Fentanyl for Post-Operative Analgesia in Lower Abdominal Surgeries: A Comparative Study
Authors/Creators
- 1. Senior Resident, Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India
- 2. Prof & Head, Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India
Description
Aim: The aim of this study to compare the epidural butorphanol, Nalbuphine, and fentanyl for post-operative analgesia in lower abdominal surgeries. Methods: This prospective randomized double-blind study was done the Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India, from July 2019 to June 2020. A total of 60 patients were included in this study. Patients were randomly divided into three groups of 20 each. Group A – Butorphanol group, Group B – Fentanyl group and Group C – Nalbuphine group. 60 patients of age ranging from 20 to 60 years (20 in each group) of the American Society of Anesthesiologists (ASA) I and ASA II group were selected on the basis of inclusion and exclusion criteria outlined below. Results: The mean time of onset of analgesia was 11.88 minutes, 6.87 minutes, and 14.89 minutes in Groups A–C, respectively. Statistical analysis showed that onset of analgesia was faster in fentanyl group compared to other two groups (p<0.05). The mean duration of analgesia was 484.71 minutes in Group A, 181.55 minutes in Group B and 297.65 minutes in Group C. The duration was thus significantly longer in butorphanol group.There mean RR increased 6-8 hrs onward postoperatively in Group Ι, 4 hrs onward in Group B and immediately postoperatively in Group C. This hyperventilation was probably due to the onset of pain after analgesic effect of respective drugs curtailed off over time. The rate came down after administration of rescue analgesic, further confirming the assumption. The mean pain score recorded was significantly lower in Groups A and B than in Group C. All the patients in Groups B and C required analgesic supplementation within first 2-4 hrs and 4-6 hrs, respectively. Whereas 7 patients of Group A required supplementation within 6-8 hrs, 14 patients between 8 and 10 hrs. Conclusion: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of post-operative pain relief. The addition of fentanyl produces faster onset of analgesia with adverse effects like sedation and pruritus than butorphanol and nalbuphine when given epidurally along with 0.125% bupivacaine.
Abstract (English)
Aim: The aim of this study to compare the epidural butorphanol, Nalbuphine, and fentanyl for post-operative analgesia in lower abdominal surgeries. Methods: This prospective randomized double-blind study was done the Department of Anaesthesia and Critical Care, Patna Medical College and Hospital, Bihar, India, from July 2019 to June 2020. A total of 60 patients were included in this study. Patients were randomly divided into three groups of 20 each. Group A – Butorphanol group, Group B – Fentanyl group and Group C – Nalbuphine group. 60 patients of age ranging from 20 to 60 years (20 in each group) of the American Society of Anesthesiologists (ASA) I and ASA II group were selected on the basis of inclusion and exclusion criteria outlined below. Results: The mean time of onset of analgesia was 11.88 minutes, 6.87 minutes, and 14.89 minutes in Groups A–C, respectively. Statistical analysis showed that onset of analgesia was faster in fentanyl group compared to other two groups (p<0.05). The mean duration of analgesia was 484.71 minutes in Group A, 181.55 minutes in Group B and 297.65 minutes in Group C. The duration was thus significantly longer in butorphanol group.There mean RR increased 6-8 hrs onward postoperatively in Group Ι, 4 hrs onward in Group B and immediately postoperatively in Group C. This hyperventilation was probably due to the onset of pain after analgesic effect of respective drugs curtailed off over time. The rate came down after administration of rescue analgesic, further confirming the assumption. The mean pain score recorded was significantly lower in Groups A and B than in Group C. All the patients in Groups B and C required analgesic supplementation within first 2-4 hrs and 4-6 hrs, respectively. Whereas 7 patients of Group A required supplementation within 6-8 hrs, 14 patients between 8 and 10 hrs. Conclusion: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of post-operative pain relief. The addition of fentanyl produces faster onset of analgesia with adverse effects like sedation and pruritus than butorphanol and nalbuphine when given epidurally along with 0.125% bupivacaine.
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IJTPR,Vol11,Issue5,Article10.pdf
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Additional details
Dates
- Accepted
-
2021-08-15
Software
References
- 1. Camann WR, Hurley RH, Gilbertson LI, Long ML, Datta S. Epidural nalbuphine for analgesia following caesarean delivery: Dose-response and effect of local anaesthetic choice. Can J Anaesth 1991;38(6):728-32. 2. Venkatraman R, Sandhiya R. Evaluation of efficacy of epidural butorphanol tartarate for post-operative analgesia. Int J Pharm Pharm Sci 2015;7(2):52-4. 3. Hurley RH, Camann WR, B Gilbertson LI, Long ML, Datta S. Epidural nalbuphine for analgesia following caesarean delivery: Dose-response and effect of local anaesthetic choice. Can J Anaesth 1991;38(6):728-32. 4. Malik P,Malhotra N,Manchanda C,. Comparative evaluation of epidural fentanyl and butorphanol for postoperative analgesia. J Anesthesiol Clin Pharmacol 2006; 22:377-82. 5. Mok MS, Tsai YJ, Ho WM. Efficacy of epidural butorphanol compared to morphine for the relief of post-operative pain. Anaesthesiology 1986;65: A175 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;8(2):167-71. 7. Malik P, Manchanda C, Malhotra N. Comparitive evaluation of epidural fentanyl and butorphanol for postoperative analgesia. J Anesthesiol Clin Pharmacol 2006; 22:377-82. 8. Abboud TK, Moore M, Zhu J, Murakawa K, Minehart M, Longhitano M, et al. Epidural butorphanol or morphine for the relief of postcesarean section pain Ventilatory responses to carbon dioxide. Anaesth Analg 1987;66(9):887-93 9. Chatrath V, Attri JP, Kaur S. Epidural nalbuphine for post-operative analgesia in orthopaedic surgery. Anesth Essays Res 2015;9(3):326-30. 10. Venkatraman R, Sandhiya R. Evaluation of efficacy of epidural butorphanol tartarate for post-operative analgesia. Int J Pharm Pharm Sci 2015;7(2):52-4.