Comparison of Post Cesarean Analgesia with Epidural BupivacaineFentanyl v/s Bupivacaine-Nalbuphine v/s Bupivacaine-Butorphanol – A Double Blinded Randomized Study

Abstract

OBJECTIVE: Comparison and study of post cesarean analgesia and side effect profile of epidural 0.125% bupivacaine-fentanyl v/s 0.125% bupivacaine-nalbuphine v/s 0.125% bupivacaine – butorphanol. DESIGN: Randomized, double-blinded study. 80 ASA physical status I and II women, aged 20-30 years, undergoing Elective Cesarean Section. INTERVENTIONS: Patients were randomly allocated to four groups during the postoperative period to receive one of four epidural regimens: Group 1(NS): 10ml of 0.125% Bupivacaine + 1ml of Normal Saline; Group 2(FENT) 10ml of 0.125% Bupivacaine + 50ug of Fentanyl (1ml); Group 3(NALB) 10ml of 0.125% Bupivacaine + 5mg of Nalbuphine(0.5ml) +0.5ml of Normal saline to make it into 1ml; Group 4 (BUTOR): 10ml of 0.125% Bupivacaine + 1mg of Butorphanol (1ml). MEASUREMENTS: Onset and duration of analgesia were recorded. Hemodynamic variables, pain scores, sedation scores, and respiratory rate were monitored for 24 hours. Frequency and severity of respiratory depression, sedation, pruritus, nausea, and vomiting were recorded. RESULTS: The data of only 77 patients were included for calculation because 3 patients were dropped from the study as they had patchy sensory blockade to an extent of converting to GA. There was no statistically significant difference in demographic parameters. The mean onset of analgesia and times to reach peak analgesia were significantly shorter while the mean durations of analgesia were significantly longer in the groups receiving fentanyl, nalbuphine & butorphanol than in the group receiving bupivacaine alone. The onset of analgesia was earliest with Butorphanol group (3.42min) followed by fentanyl group(4.20min), Nalbuphine roup(5.42min) & finally by control group(8.22min). The duration of analgesia was maximum with Butorphanol group (mean of 360min), followed by Fentanyl group (mean of 280min), Nalbuphine group (mean of 245) & control group (mean of 211min). Satisfaction with the pain relief given was assessed by 1. Ability for independent side to side movement 2. VAS for satisfaction. It was observed that satisfaction was more with Butorphanol group followed by Nalbuphine group, Fentanyl group & by control group in the descending order. Sedation was observed in all the groups (Control – 17%, Fentanyl – 25%, Nalbuphine – 58%, Butorphanol – 63%. Butorphanol & Nalbuphine groups had more incidence of sedation & higher grades of sedation (Grade 4) Nausea & Vomiting was observed in both control group (incidence of 6%) & fentanyl group (incidence of 20%) Pruritus was observed only in the fentanyl group with a incidence of 15%. None of the patients developed hypotension, Bradycardia, respiratory depression. CONCLUSIONS: Epidural 0.125% Bupivacaine combined with Butorphanol produces significantly earlier onset, longer duration and better quality of analgesia than 0.125% Bupivacaine - Nalbuphine combination / 0.125% Bupivacaine -Fentanyl combination / 0.125% Bupivacaine alone and is safe in parturients.