A study on compare the efficacy of epidural, bupivacaine with buprenorphine and bupivacaine with fentanyl in lower limb surgeries

Abstract

Background and Objectives: Pain is a complex subjective experience which has proved difficult to measure in reproducible way. It is found that operative pain is more severe after surgery and thereafter gradually diminishes over next 24 hours. Providing effective analgesia for patients undergoing major surgery is a daily challenge for most anaesthetists. Methods: 60 patients in the age group 20-60 years belonging to ASA I-II posted for elective lower limb surgeries were studied. The patients were divided in to two groups of 30 each. Group A- 0.5% Bupivacaine 15ml (75mg) with 0.5ml (150 ug) Buprenorphine (preservative free) Group B- 0.5% Bupivacaine 15ml (75mg) with 1ml (50ug) Fentanyl(preservative free) Intraoperatively, sensory and motor blockade, quality and duration of Postoperative analgesia, hemodynamic and respiratory parameters, side effects like nausea, vomiting, respiratory depression, urinary retention, pruritus were studied. Patients were monitored for 48 hours postoperatively to look for any delayed complications. Results: Addition of 50 mcg fentanyl to 0.5 % bupivacaine (group B) resulted in faster onset of sensory and motor blockade which was statistically insignificant compared to 150mcg buprenorphine with 0.5% bupivacaine (group A). Duration of analgesia was significantly longer in Group A with mean duration of 766.6 minutes as compared to 471 min in Group B. Both the groups provided a good hemodynamic stability. There was no significant respiratory depression in both the groups. The incidence of Nausea and vomiting was more in group A (40 %) compared to group B (10 %) and mild pruritus which did not require any treatment was more in group B (10%) compared to none in group A. Conclusion: In this comparative study an effort was made to study the peri operative analgesic efficacy of Inj. Buprenorphine and Inj. Fentanyl with 0.5 % Bupivacaine epidurally for lower limb surgeries. There were no significant hemodynamic and respiratory side effects in either of the groups. Both buprenorphine and fentanyl along with bupivacaine 0.5% can be given epidurally as a single shot injection for perioperative analgesia obviating the need for epidural catheter