A comparison between epidural Butorphanol and Tramadol for postoperative analgesia, sedation and side effects using CSEA technique for surgeries below the level of umbilicus

Preeti More,Charchill Wagh,Vandana Laheri

doi:10.7439/ijbar.v7i11.3730

Abstract

Background and Aims: Epidural analgesia using low doses of local anesthetic agent with or without adjuvants like opioids is a popular, simple, effective and economical way of providing postoperative analgesia. We proposed to evaluate and compare the efficacy of epidural opioids, Butorphanol and Tramadol using Combined Spinal Epidural Analgesia (CSEA) technique for surgeries below the level of umbilicus for postoperative analgesia, sedation and side effects.Methods: In this prospective, double blind, randomized controlled clinical trial, 60 patients aged 18 to 60 years, ASA grade 1 or 2 posted for planned elective surgery below the level of umbilicus were selected.Study Design: The patients were randomly allocated into 2 groups to receive postoperatively either 1 mg of inj. Butorphanol (dissolved in 10 ml of normal saline) (Group B) or 50 mg of inj. Tramadol (dissolved in 10 ml of normal saline) (Group T) epidurally as a bolus dose when the VAS score for pain was more than 4 after the conclusion of surgical procedure as the effect of spinal anaesthesia started wearing off.Statistics and Results: The mean duration of analgesia with tramadol (group T) 6.481 ( 0.86842) hrs. was significantly higher than with butorphanol (group B) i.e., 5.352 (0.33258) hrs with a p value of 0.0001. Pain scores were also significantly lower statistically in group B as compared to group T. Sedation scores were significantly higher in group B than group T, which was statistically highly significant (p= 0.0001).Conclusion: Both epidural, butorphanol and tramadol provided good postoperative analgesia. The duration of analgesia was longer with tramadol, quality of analgesia was better with butorphanol, sedation more with butorphanol as compared to tramadol and other side effects were comparable.

Highlights

Combined spinal and epidural anaesthesia technique (CSEA) [1] is a regional anaesthetic technique which combines benefits of spinal anaesthesia and epidural anaesthesia and analgesia
A mixed agonist antagonist opioid and tramadol hydrochloride a moderately potent opioid agonist have been used for this purpose separately in few studies [3,4] We conducted this study, to compare epidural Butorphanol and Tramadol for postoperative analgesia, sedation and side effects using Combined Spinal Epidural Analgesia (CSEA) technique for surgeries below the level of umbilicus
Preeti More et al/ A comparison between epidural Butorphanol and Tramadol for postoperative analgesia, sedation and side effects 538 prospective study was done on 60 patients of ASA status (1 or 2) aged between 18- 60 years for planned elective surgery below the level of umbilicus under combined spinal epidural anaesthesia

Summary

Introduction

Combined spinal and epidural anaesthesia technique (CSEA) [1] is a regional anaesthetic technique which combines benefits of spinal anaesthesia and epidural anaesthesia and analgesia. Fentanyl have been employed in the search for near ideal agent, which remains elusive[3] Butorphanol tartrate, a synthetic morphinian derivative is a mixed agonist-antagonist non narcotic analgesic of the phenanthrene series while tramadol is a centrally acting opioid agonist of aminocyclohexanol group Both butorphanol, a mixed agonist antagonist opioid and tramadol hydrochloride a moderately potent opioid agonist have been used for this purpose separately in few studies [3,4] We conducted this study, to compare epidural Butorphanol and Tramadol for postoperative analgesia, sedation and side effects using CSEA technique for surgeries below the level of umbilicus. Sedation scores were significantly higher in group B than group T, which was statistically highly significant (p= 0.0001) Conclusion: Both epidural, butorphanol and tramadol provided good postoperative analgesia. The duration of analgesia was longer with tramadol, quality of analgesia was better with butorphanol, sedation more with butorphanol as compared to tramadol and other side effects were comparable Keywords: Epidural, tramadol, butorphanol, postoperative analgesia

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