A COMPARISON OF EFFICACY OF EPIDURAL BUTORPHANOL AND FENTANYL FOR POST-OPERATIVE PAIN ANALGESIA IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES UNDER EPIDURAL ANESTHESIA: A PROSPECTIVE RANDOMIZED DOUBLE-BLINDED STUDY

PRAVEEN KUMAR; BHUPENDRA SINGH; HARSHA D; VIKRAM SINGH RATHORE

doi:10.22159/ajpcr.2024v17i10.52123

Authors

PRAVEEN KUMAR Department of Anaesthesiology and Critical Care, Yashoda Hospital and Research Center, Ghaziabad, Uttar Pradesh, India https://orcid.org/0009-0004-3827-5170
BHUPENDRA SINGH Department of Anaesthesiology and Critical Care Medicine, INHS Sanjivani, Kochi, Kerala, India.
HARSHA D Department of Anaesthesiology and Critical Care, Medipulse Tertiary Care Hospital, Jodhpur, Rajasthan, India https://orcid.org/0000-0002-4651-2242
VIKRAM SINGH RATHORE Department of Anaesthesiology and Critical Care, Uttar Pradesh University of Medical Sciences, Saifai, Uttar Pradesh, India.

DOI:

https://doi.org/10.22159/ajpcr.2024v17i10.52123

Keywords:

Epidural anesthesia, butorphanol, fentanyl, Postoperative analgesia

Abstract

Objective: Lower doses of epidural opioids can achieve post-operative analgesia for infraumbilical surgeries. A study was conducted to compare the efficacy of epidural butorphanol and fentanyl for post-operative analgesia, onset, duration, and side effects in infraumbilical surgeries.

Methods: A study was conducted on 80 adult patients, both male and female, aged between 20 and 60 years, having American Society of Anesthesiologists Physical Status I and II, who were undergoing lower abdominal and lower limb surgeries under epidural anesthesia. The patients were randomly divided into two groups: Group A and Group B. Both groups were given injections of bupivacaine 20 mL of 0.5% epidurally. In the post-operative period, when the patient’s Visual Analog Scale score was more than 4, Group A was administered butorphanol 2 mg followed by top-up doses of 0.5 mg, and Group B was administered fentanyl 50 μg followed by top-up doses of 15 μg, which were diluted to 10 mL in normal saline. Along with cardiorespiratory parameters, the study also noted onset, duration, quality of analgesia, and the number of epidural doses in 24 h. The statistical analysis was done using Student’s t-test and two-tailed Fisher’s exact test or Chi-square (χ2) test, and a significant value of p<0.05 was considered.

Results: In comparing the post-operative analgesia between both groups, it was found that Group B had significant early onset of analgesia (2.600±0.4557 vs. 6.087±0.7501), shorter duration of analgesia (200.08±26.257 vs. 366.25±42.829), a higher number of epidural doses administered (3.75±1.171 vs. 2.98±0.733), lower quality of analgesia (2.55±0.504 vs. 3.18±0.636), and a greater incidence of vomiting (30.0% vs. 2.5%) when compared to group A.

Conclusion: Superior analgesia with higher sedation can be achieved through epidural butorphanol, while fentanyl has a quicker onset of analgesia but a higher tendency for vomiting. Our conclusion is that both options, fentanyl and epidural butorphanol, are safe and effective for achieving post-operative pain relief.

Downloads

Download data is not yet available.

References

Hunt CO, Naulty JS, Malinow AM, Datta S, Ostheimer GW. Epidural butorphanol-bupivacaine for analgesia during labour and delivery. Anesth Analg. 1989;68:323-7.

Bharti N, Chari P. Epidural butorphanol-bupivacaine analgesia for postoperative pain relief after abdominal hysterectomy. J Clin Anesth. 2009;21:19-22.

Shrestha CK, Sharma KR, Shrestha RR. Comparative study of epidural administration of 10 ml of 0.1% bupivacaine with 2 mg butorphanol and 10 ml of 0.25% plain bupivacaine for analgesia during labour. JNMA J Nepal Med Assoc. 2007;46:1-6.

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

Pokharel K, Rahman TR, Singh SN, Bhattarai B, Basnet N, Khaniya S. The efficacy and safety of low-dose epidural butorphanol for postoperative analgesia following cesarean delivery. JNMA J Nepal Med Assoc. 2008 Apr-Jun;47(170):57-61

Jose DE, Ganapathi P, Anish Sharma NG, Shankaranarayana P. Postoperative pain relief with epidural buprenorphine versus epidural butorphanol in laparoscopic hysterectomies: A comparative study. Anesth Essays Res. 2016 Jan-Apr;10(1):82-7.

Malik P, Manchanda C, Malhotra N. Comparative evaluation of epidural fentanyl and butorphanol for postoperative analgesia. J Anaesth Clin Pharmacol. 2006;22(4):377-82.

Palacios QT, Jones MM, Hawkins JL, Adenwala JN, Longmire S, Hess KR, et al. Post-caesarean section analgesia: A comparison of epidural butorphanol and morphine. Can J Anaesth. 1991;38(1):24-30.

Lytle SA, Goldsmith DM, Neuendorf TL, Lowry ME. Postoperative analgesia with epidural fentanyl. J Am Osteopath Assoc. 1991;91(6):547-50.

Sharma S, Naik S, Jamale PB, Dhulkhed VK, Prasoon A. A comparison of epidural butorphanol 2mg and fentanyl 75 mcg for postoperative analgesia using combined spinal epidural anaesthesia technique: A randomized double-blind clinical study. Int J Med Health Res. 2018 Apr;4(4):97-101.

Banerjee S, Pattnaik SK. A comparative study between epidural butorphanol, nalbuphine and fentanyl for postoperative analgesia inlower abdominal surgeries. Asian J Pharm Clin Res. 2017;10(5):383-8. doi: 10.22159/ajpcr. 2017.v10i5.16802

Kaur J, Bajwa SS. Comparison of epidural butorphanol and fentanyl as adjuvants in the lower abdominal surgery: A randomized clinical study. Saudi J Anaesth. 2014;8:167-71.

Birajdar SB, Peerzade SF, Shabeer Ali K, Sultana SS, Mohammed Afzal A. A comparative study between epidural nalbuphine and fentanyl with bupivacaine for post operative analgesia in lower limb surgeries. Int J Adv Res. 2023;11(4):1008-22.

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.

Chandra AS, Babu BV. A comparative Study between epidural butorphanol, nalbuphine, and fentanyl for post-operative analgesia in lower abdominal surgeries: A prospective randomized double-blinded trial. J Med Sci Clin Res. 2019;7(12):518-26.

Naulty JS, Johnson M, Burger GA, Datta S,Weiss JR, Morrison J. Epidural fentanyl for post cesarean delivery pain management. Anesthesiology. 1983;59:415.

Ackerman WE, Juneja MM, Kaczorowski DM, Colclough GW. A comparison of the incidence of pruritus following epidural opioid administration in the parturient. Can J Anaesth. 1989;36:388-91.