Volume : 7, Issue : 5, May - 2018

COMPARISON OF EPIDURAL BUTORPHANOL VERSUS NALBUPHINE AS ADJUVANTS WITH BUPIVACAINE FOR ABDOMINAL HYSTERECTOMY: A PROSPECTIVE RANDOMIZED DOUBLE-BLIND CONTROLLED CLINICAL STUDY

Dr. Ankita, Dr. Usha Suwalka, Dr. Mukesh Kumar, Dr. Harish Kumar

Abstract :

<p>&nbsp;Introduction: Pain is an unpleasant sensory and emotional experience associated with actual or potential tissue</p> <div>damage. The main goal of anesthesia is to provide adequate pain relief in the intraoperative and postoperative</div> <div>period. Epidural anesthesia is used for all the surgical procedures carried on lower abdomen, pelvis and lower limbs. Narcotic analgesics are</div> <div>used as adjuvants to local anesthetics in epidural anesthesia. They hasten the onset, improve the quality of block as well as prolong the</div> <div>duration of analgesia.</div> <div>Aims &amp; objectives: To evaluate the postoperative analgesic bene􀃶ts in patients administered butorphanol and nalbuphine as adjuvants</div> <div>with bupivacaine for abdominal hysterectomy under epidural anesthesia and to compare their postoperative efficacy with respect to</div> <div>increase in duration of analgesia, reduction in total requirements of analgesics postoperatively and to study the side effects and</div> <div>complications.</div> <div>Materials &amp; methods: The prospective randomized double blind study was done in 90 patients of ASA 1 &amp; 2 in the age group of 30-60 years,</div> <div>randomly divided into three groups of 30 each according to the epidural medications they received:Group C (n=30): Inj. bupivacaine 0.5%</div> <div>(20 ml),Group B (n=30): Inj. bupivacaine 0.5% (19 ml)+Inj. butorphanol 1mg (1 ml),Group N (n=30): Inj. bupivacaine 0.5% (19 ml)+Inj.</div> <div>nalbuphine 10mg (1 ml). Hemodynamic parameters and various block characteristics were observed and recorded. Sensory block was</div> <div>assessed by pin-prick method, motor block was assessed by Bromage Scale and pain was assessed on VAS scale. Rescue analgesic 0.5% 2.5</div> <div>ml bupivacaine and normal saline diluted to make 10 ml when VAS score is 4 till 24 hrs. Complications were noted and treated accordingly.</div> <div>Sedation was assessed by Wilson‘s sedation scoring. Statistical analysis was done by unpaired t test and chi square test. A ‘P‘ value &lt;0.05 was</div> <div>considered as statistically signi􀃶cant.</div> <div>Result: The mean time of onset and completion of sensory block was statistically signi􀃶cant among the three groups and even better in</div> <div>nalbuphine group compared to butorphanol group.The duration of analgesia was maximum in nalbuphine and minimum in bupivacaine</div> <div>group.There was statistically signi􀃶cant difference in the total dose of rescue analgesic required in 24 hours between the three groups, with</div> <div>maximum requirement in bupivacaine group and minimum in nalbuphine group.</div> <div>Conclusion:The addition of opioids like butorphanol and nalbuphine as adjuvants to bupivacaine for epidural anesthesia decrease the time</div> <div>of onset and completion of sensory block, the quality of analgesia is better, with lesser side effects and requiring lesser dose of rescue</div> <div>analgesic in postoperative period.</div>