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Category: Volume 06 Issue 03 March 2018
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Title: To Compare the Safety and Efficacy of Anaesthesia and Analgesia between Intrathecal Fentanyl and Butorphanol as Adjuvants with Bupivacaine 0.5% Heavy for Lower Limb Orthopaedic Procedures

Authors: Dr Suresh Kumar Esampalli, Dr P Rajeswar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i3.183

Abstract

The aim of the study is to compare the safety and efficacy of anaesthesia and analgesia between intrathecal fentanyl and butorphanol as adjuvants with bupivacaine 0.5% heavy for lower limb orthopaedic procedures. Eighty patients of ASA grade I and II of either sex in the age group of 18 to 75 years scheduled for elective lower limb orthopaedic procedures were allocated randomly into two groups of 40 each. Group F received intrathecal inj 0.5% heavy bupivacaine2.5ml with 0.5ml inj fentanyl 25mcg while patients in group B received intrathecal inj 0.5% heavy bupivacaine 2.5ml with 0.5ml inj butorphanol 25mcg. Intra-operative hemodynamic parameters (HR, SBP, DBP, RR, SPO2) were noted. Results were compared among the groups using the student t test and chi square test. In all cases, p < 0.05 was considered statistically significant. The time taken to attain highest sensory level and time of onset of maximum bromage grade 3 motor blockade were comparable among the two groups. Significantly slower sensory block regression to S2 dermatome level was observed in the group receiving intrathecal butorphanol as compared to intrathecal fentanyl. A higher number of patients ingroup F requested for rescue analgesia during the postoperative period than in group B.  It was concluded that Both 25mcg fentanyl and 25 mcg butorphanol given intrathecally along with12.5 mg of hyperbaric bupivacaine provide effective anaesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory blockade and superior analgesia than intrathecal fentanyl-bupivacaine mixture

Keywords: Analgesia, Anaesthesia, Bupivacaine, Butorphanol, Fentanyl, Spinal

References

  1. Srivastava U, Kumar A, Saxena S, Saxena R, Gandhi NK, Salar P. Spinal anaesthesia with lignocaine and fentanyl. Indian J Anaesth. 2004; 48(2): 121- 123.
  2. Stocks GM, Hallworth SP, Fernando R, England AJ, Columb MO, Lyons G. Minimum local analgesic dose of intrathecal bupivacaine in labor and the effect of intrathecal fentanyl. Anaesthesiology 2001; 94:593-8.
  3. Biswas BN, Rudra A, Bose BK, Nath S, Chakrabarty S, Bhattacharjee S.Intrathecal fentanyl with hyperbaric bupivacaine improves analgesia during caesarean delivery and in early postoperative period. Indian J. Anaesth. 2002; 46(6): 469-472.
  4. Singh V, Gupta LK, Singh GP. Comparison among intrathecal fentanyl and butorphanol in combination with bupivacaine for lower limb surgeries.J Anaesth Clin Pharmacol. 2006; 22(4): 371-375.
  5. Ozkardesler S, Gurpinar T, Akan M, Koca U, Sarikaya H, Olmez T et. al. A possible perianaesthetic serotonin syndrome related to intrathecal fentanyl. J Clin Anaesth. 2008; 20(2): 143-145.
  6. Commiskey S, Fan LW, Ho IK, Rockhold RW. Butorphanol: Effects of a prototypical   Agonist-antagonist analgesic on kappa-opioid receptors. J Pharmacol Sci 2005;98:109-116.
  7. Abboud TK, Moore M, Zhu J, Murakawa K, Minehart M, Longhitano M, et al. Epidural Butorphanol or morphine for the relief of post-caesarean section pain: Ventilatory responses to carbon dioxide. Anesth Analg 1987; 66:887-93
  8. Bromage PR. Epidural Analgesia. Philadelphia; WB Sanders; 1978; 144.
  9. Brown DT, Wildsmith JA, Covino BG, Scott DB. Effect of baricity on spinal anaesthesia with amethocaine. British journal of anaesthesia 1980; 52: 589-95.
  10. Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecalfentanyl Andsufentanil in low-dose dilute bupivacaine spinal anaesthesia fortransurethral prostatectomy. Br J Anaesth 2009; 103:750-4.
  11. Wongchanapai W, Tsang BK, He Z, Ho IK. Relative involvement of spinal opioid receptors in physical dependence on intrathecal butorphanol and morphine. Pharmacol Biochem Behav1998;60:899-907
  12. Kumar B, Williams A, Liddle D, Verghese M. Comparison of intrathecal bupivacaine-      Fentanyl and bupivacaine-butorphanol mixtures for lower limb orthopedic procedures. Anesth Essays Res 2011;5:190-5.
  13. Hamber EA, Viscomi CM. Intrathecal lipophilic opioids as adjuncts to surgical spinal anaesthesia. Reg Anesth Pain Med 1999; 24:255-63.
  14. Ranga Chari VR, GoyalAA, Singh V. A study of addition of Inj.Butorphanol to hyperbaric Inj. Bupivacaine given intrathecally to patients undergoing lower segmentcaesareansection: A randomized, controlled trial. Med J DY Patil Univ 2013;6:156-60
  15. Nair GS, Abrishami A, Lermitte J, Chung F. Systematic review of spinal anaesthesia using bupivacaine for ambulatory knee arthroscopy. Br J Anaesth 2009; 102:307-15
  16. Kamphuis ET,  Ionesco TI,  Kuipers PW, De Gier J, Van Venrooij GE, Boon TA.Recovery of storage and emptying functions of the urinary bladder afterspinal anaesthesia with lidocaine and with bupivacaine in men. Anaesthesiology1998; 88: 310-6.

Corresponding Author

Dr P Rajeswar

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