A Comparative Study Of Butorphanol As An Adjunct To Bupivacaine In Comparison To Bupivacaine Alone.

Abstract

Neuraxial opioids are widely used in conjunction with local anaesthetics (LA) as they permit the use of lower dose of LA while providing adequate anaesthesia and analgesia. Neuraxial opioids also allow prolonged analgesia in the postoperative period and faster recovery from spinal anaesthesia. Antinociceptive synergism between LA and intrathecal opioids has been demonstrated in various animal studies. The present study was undertaken to compare the safety and efficacy of anaesthesia and hemodynamic stability of different doses of intrathecal bupivacaine-butorphanol mixture with intrathecal bupivacaine alone for lower abdominal & lower limb surgery. This study was conducted as only a limited number of studies have explored the use of intrathecal butorphanol in human subjects previously. Butorphanol is a lipophilic opioid agonist-antagonist analgesic with a published affinity for opioid receptors in vitro of 1:4:25 (mu: delta: kappa). Studies have reported a dose-dependent increase in the duration of analgesia provided by epidural butorphanol for relief of post-caesarean section pain. I. Methods Fourty six patients of ASA grade I and II between 18-58yrs of age of either sex, scheduled for elective lower abdominal & lower limb surgical procedure were included The study protocol was approved by Institutional Ethical Committee and written informed consent was obtained from all patients. The pre-anaesthetic check-up included a detailed medical and surgical history, and any previous anaesthetic exposure with its outcome. General examination includes general condition, built, weight, pulse rate, blood pressure, respiratory rate, and presence of cyanosis, anaemia, clubbing, jaundice or edema. A careful thorough systemic examination was done to rule out any cardiovascular, respiratory, gastrointestinal and neurological or any other systemic illness.Routine biochemistry investigation included haemoglobin, total leucocyte count, differential leucocyte count, blood sugar, blood urea, and serum creatinine, were done in all patients. ECG and X-Ray Chest were done in patients where indicated and in those over 40 years of age along with other relevant investigation. After taking detailed history and thorough clinical examination, the patients were excluded from the study on the basis of below mentioned criteria: Patients with systemic hypertension, hepatic dysfunction, renal dysfunction, endocrine dysfunction, cardiac dysfunction, morbid obesity (body weight more than 20% of the ideal body weight),Other exclusion criteria were patients with known drug hypersensitivity, those on antihypertensive medication or antidepressant