A COMPARITIVE STUDY BETWEEN EPIDURAL BUTORPHANOL, NALBUPHINE AND FENTANYL FOR POSTOPERATIVE ANALGESIA IN LOWER ABDOMINAL SURGERIES
Background: Achieving satisfactory post-operative analgesia with neuraxial administration of narcotics has been the subject of much research. The use of epidural opioids had become an increasingly popular technique for management of acute post-operative pain in recent times. This study evaluates post-operative analgesic benefits in patients administered epidural butorphanol, nalbuphine, and fentanyl as adjuvants with local anesthetics postoperatively for surgery under epidural anesthesia.
Methods: A total of 75 patients belonging to age groups 18-60 years who were scheduled for surgeries of lower abdomen were randomly divided into groups of 25 each. Epidural technique was adopted for surgery of the lower abdomen for all patients with 0.5% bupivacaine. In the post-operative period, the study drug was given through epidural catheter. Group A received butorphanol 2 mg, Group B received fentanyl 100 Î¼g, and Group C received nalbuphine 10 mg with 0.125% bupivacaine diluted to 10 ml in normal saline each. Onset, duration, quality of analgesia, hemodynamic changes, and side effects â€“ such as sedation, pruritus, nausea, vomiting, respiratory depression, and urinary retention - were recorded and compared.
Results: The demographic data were comparable in all three groups. The onset of sensory block was significantly earlier in Group B (fentanyl) than other two groups. Duration was significantly longer in Group A (butorphanol). No serious cardiorespiratory side effects were noted in any of groups.
Conclusion: Fentanyl produces the faster onset of analgesia with adverse effects like pruritus. Butorphanol administered epidurally has the advantage of longer duration of analgesia than fentanyl or epidural nalbuphine with side effects such as nausea, vomiting, and sedation.
2. Veena Chatrath, Joginder Pal Attri and Sawinder Kaur. Epidural nalbuphine for postoperative analgesia in orthopaedic surgery; Anesthesia, Essays and Researches 2015 Sep- Dec:9(3) : 326- 330
3. Camann WR, Hurley RH, Gilbertson LI, Long ML, Datta S,.Epidural nalbuphine for analgesia following caesarean section, delivery dose response and effects of local analgesic dose -. Canadian journal of anesthesia,1991.
4. Malik P, Manchanda C, Malhotra N. Comparitive evaluation of epidural fentanyl and butorphanol for postoperative analgesia. Journal of anesthesiology Clinical pharmacology. 2006;22:377-82
5. Ashok Kumar Saxena, Shiva Kumar Arava. Current concepts in neuraxial administration of opioids and non-opioids: An overview and future prospectives. Indian J. Anaesth 2004.
6. D.C. Tripathi, Vandana S. Mehta, Pramila S. Jha, Komal S. Shah, Lopa P. Trivedi- A Comparative Study of Epidural Tramadol versus Butorphanol for Post-Operative Pain Relief in Abdominal Hysterectomy (Indian society for study of pain,2009)
7. Rutter DV, Skewes DG and Morgan M. Extradural opiods for postoperative analgesia. A double-blind comparison of pethidine, fentanyl and morphine. Br J Anaesth(1981)
8. Mok MS , Tsai YJ, et al. Efficacy of epidural butorphanol compare to morphine for the relief of postoperative pain. Anaesthesiology 1986
9. Therese K Abboud, M Moore, J Zhu, K Murakawa, M Minehart, M Longhitano, J Terrasi, ID Klepper et al., Epidural butorphanol or morphine for the relief of postcesarean section pain Ventilatory responses to carbon dioxide Anaesth Analg 1987
10. JS Naulty, S Weintraub, J Mcmahon, Ostheimer C Hunt, R Chantigian. Epidural butorphanol for postcesarean delivery pain management
11. Maurice Lippmann, Martin S Mok. Epidural butorphanol for relief of postoperative pain. Anaesth Analg 1998
12. Catherine O Hunt, J Stephen Naulty, Andrew M Malinow, Sanjay datta, Gerard W Ostheimer. Epidural butorphanol-Bupivacaine for analgesia during labour and delivery. Anaesth Analg 1989; 68:323-7.
13. Palacios, Monica M Jones, Joy L Hawkins, Jayshree N Adenwala, Stephen Longmire, Kenneth R Hess, Barbara S Sknjonsby et al., Postcesarean section analgesia: a comparison of epidural butorphanol and morphine. Can J Anaesth 1991
14. Welchew EA. The optimum concentration for epidural fentanyl. A randomized, double-blind comparison with and without1:200000 adrenaline. Anaesthesia 1983.
15. Kim DH, Kim TJ, Park NH. Comparison of Butorphanol and Fentanyl Administered with Bupivacaine for Patient Controlled Epidural Analgesia after Cesarean Section,Jan 1998
16. Hwang KB, Chung CJ, Lee JH, Lee SC, Oh SH. Comparison of Butorphanol and Fentanyl for Patient-Controlled Epidural Analgesia after Gastrectomy. Journal on Korean Pain Soc 2004 Jun; 17(1): 24-48.
17. The Efficacy and Safety of Low Dose Epidural Butorphanol on Postoperative Analgesia following Cesarean Delivery- Pokharel K,Rahman TR, Singh SN,Bhattarai B, Basnet N, Khaniya S(2008)
18. Salomaki, Timo E, Jorma D Laitinen, Lauri S. Nutinen. A radomized double blind comparison of epidural versus intravenous fentanyl infusion for analgesia after thoracotomy. Anaethesiology 1991
19. Comparison of the analgesic and respiratory effects of epidural nalbuphine or morphine in postthoracotomy patients.-Etches RC, Sandler AN, Lawson SL European journal of anesthesia(2007)
20. Patient-controlled epidural analgesia: interactions between nalbuphine and hydromorphone.- Parker RK, Holtmann B, White PF.(anesthesia-analgesia,1997)
21. A dose-response study of nalbuphine for post-thoracotomy epidural analgesia-Baxter AD, Langaniere S, Samson B, McGilveray IJ, Hull K. ( Canadian journal of anesthesia,1991)
22. Comparative Study of Intrathecal Fentanyl versus Intrathecal Clonidine with low dose Bupivacaine for Lower Abdominal and Lower Limb Surgery-R.G. Bakhshi, N.K. Bobby, S.R.Jagtap(ISSP JOURNAL-2009)