Comparison of Plain Bupivacaine, Bupivacaine-Butorphanol Combination and Bupivacaine-Fentanyl Combination for Post Operative Epidural Analgesia - A Tertiary Care Teaching Centre Experience

Title: Comparison of Plain Bupivacaine, Bupivacaine-Butorphanol Combination and Bupivacaine-Fentanyl Combination for Post Operative Epidural Analgesia - A Tertiary Care Teaching Centre Experience

Authors: Sheeila Rani Imanual, Meena Vijayaraghavan, Jamuna Rani J

DOI: https://dx.doi.org/10.18535/jmscr/v5i4.36

Abstract

Background: International association for the study of pain (IASP) defines pain as “an unpleasant sensory and emotional experience, associated with actual or potential tissue damage or described in terms of such damage”. Effective pain control is essential for optimal care of surgical patients. Unrelieved pain causes reduction in vital capacity, FRC, tidal volume, all of which lead to hypoxemia, hypercarbia, retention of secretions atelectasis and pneumonia. Postoperative pain can be relieved by using different drugs & different techniques. Epidural analgesia has revolutionized postoperative pain management. aim of the study was to compare the duration of postoperative analgesia for lower abdomen surgeries and other effects produced by epidural injection of 0.25% plain bupivacaine versus 0.25% bupivacaine-butorphanol 2mg, versus 0.25% bupivacaine- fentanyl 50mcg.

Methods: The patients were posted to undergo surgery at SAT hospital medical college Trivandrum during 2012-2014. The study was approved by hospital ethics committee. Seventy-five patients undergoing lower abdominal surgeries were randomly selected for this study. Patients were those undergoing elective surgery that could be performed under lumbar epidural anesthesia ASA physical status grade I and II patients of female sex between 35-60 yrs of age and body weight -ranging from 45- 70 Kg.

Results: The patients were selected at random to avoid any kind of bias and to allow comparability of results obtained in three groups. The three groups were comparable with regards to mean age and weight and sex distribution.The mean onset of time of pain relief in bupivacaine (group I), bupivacaine butorphanol combination (group II) and bupivacaine fentanyl combination (group III) had been 16.92 ± 1.35, 10.98 ± 1.38, 13.24 ± 1.02 minutes respectively. There is highly significant difference among the three groups (P value os 0.000). Bupivacaine butorphanol combination has a faster onset time compared other groups.

Conclusions: butorphanol given along with 0.25% bupivacaine epidurally for lower abdominal surgeries is a safe and effective analgesic for postoperative pain relief, when compared with 0.25% bupivacaine alone and 25% bupivacaine with fentanyl. The addition of epidural butorphanol to 0.25% bupivacaine cause significantly effective analgesia for a prolonged period

Keywords: Bupivacaine, Butorphanol, Epidural Analgesia,Fentanyl, postoperative pain relief.

References

1. Black RG. The chronic pain syndrome! Surgical clinics of North America 1975; 55:999-1011.

2. Nageman J: measurement and controlof postoperative pain. Ann R Coll- surg. Engl 6: 419,1979.

3. Bonica JJ: Current status of postoperative pain therapy. Yokota T, Dubaner R: Current Topics in Pain Research and Therapy Amsterdam, Exarpta Medica. 1983, P. 169.

4. Carr DB, Jacox AK, Chapman RC et al: Clinical Practice Guideline: Acute Pain Management: Operative or Medical Procedures and Trauma. Rockville, Md, Agency for Health Care Policy and Research. U.S Department of Health and Human Services 1992.

5. Ronald D Miller: Anesthesia 5^th edition. 2000.

6. Jhon D. Loeser; Sleptrex. H. Butleer: Richard. C. Chapman, Bonica’s Manage-ment of Pain 3^rd edition, 2001.

7. I ASP. Sub-Committee on Taxonomy. Painterm: a list with definitions and notes on usage. Pain 1980; 249-52.

8. Duggan J, Drummond GBF: Activity of lower intercostal and abdominal muscle after surgery in humans. Anasth Analg 66:852,1987.

9. Modig J: Thromboembolism and blood loss: continuous epidural versus general anesthesia with controlled ventilation. Reg Anesth 7:884,1982.

10. Tuman KJ, Me Carthy RJ, Delaria GA, patel RV, Ivan Kovich AD. Effects of epidural anesthesia and analgesia on coagulation and outcome after major vascular surgery. Anesthesia and Analgesia 1991;73:696-704.

11. Catley DM, Thronton C, Jordon C et al: Pronounced episodic oxygen desaturation in the postoperative period: Its association with ventilatory pattern and analgesic regimen. Anesthesiology 63:20,1985.

12. Brose WG, Cobn SE: oxyhaemoglobin saturation following cesarean section in patients receiving epidural morphine, PCA, or IM meperidine analgesia. Anesthesiolgy 70:948,1989.

13. Miller RR, greenbalt-DJ : Drug Effects in Hospitalized Patients. NewYOrk, Jhon Wiley & sons 1976.

14. Reiz S, West berg M: Side Effects of Epidural Morphine: Lancet 2:203,1980..

15. Bonica JJ : The Management of Pain Philadelphia, Lea&Febigor, 1953.

16. Keblet H : Pain Relief and Modification of the Stress Response. Cousins MJ, Philips GD. Acute Pain Management. New York. Churchill Livingstone 1986, p49.

17. Mcunicha S Dahl JB, Rosenberg J et al. Colonic Resection with early discharge after combined subarachnoid epidural analgesia, preoperative glucocorticoids and early postoperative mobiliztion and feeding in a pulmonary high risk patient Reg. Anesth 19: 352,1994.

18. Moore DC : intercostal nerve block for postoperative somatic pain following surgery of the thorax and upper abdomen. Br. J Anesth 47:284,1975.

19. Reiestad F, Strom Skag KE : Intrapleural catheter in the management of postoperative pain A preliminary report. Reg Anesth 11:89,1986.

20. Forrest WH, Sinethrust PWR, Kientz ME: Self administration of intravenous analgeics. Anesthesiology 33:363, 1970.

21. Yarnell RW, Polis T, Reid GN et al : Patient controlled analgesia with epidural meperidine after elective cesarean section . Reg Anesth 17:329,1992.

22. Cohn S, Amar D, Pantuck C et al : Epidural patient controlled analgesia after cesarean section: Buprenorphine-Bupivacaine with and without epinephrine. Anesth Anal 74:226,1992

23. Melzack R, Wall PQ: Pain mechanism A new theory. Science 150:971,1965

24. Melzack R: Prolonged relief of pain by brief , intense, transcutaneous somatic stimulation. Pain 1 357,1975.

25. Glynn CJ, Lloyd JW, Barnard JDW: Cryoanalgesia in the management of pain after thoracotomy Thorax 35:325,1980

26. Gourlay GK, Wilson PR, Glynn CJ: Pharmacodynamics and Pharmacokinetics of methadone during the postoperative period Anesthesiology 57:485,1982.

27. Michael Ferrante. F . Timothy R, Vade Boncaner, postoperative pain management. 1^st edition 1993.Pp:305-328

28. Patrie. D. Wall, Ronald Melzac, Text book of pain 4^th edition 1999Pp 1220-1224

29. Michael. J. cousins and Philip.O. Bridenhaugh, Neural Blockade in Clinical Anesthesia and Management Pain, 3^rd edition, 1999

30. Vincent.J.Collins: Principles of Anesthes-iology 3^rd edition.

31. Bentley JB, Borel JD et al . Age and fentanyl pharmacokinetics. Anesth Analg 61: 968, 1982

32. Me Clain DA, Hug CC Jr: Intravenous fentanyl Kinetics. Clin Pharmaco Ther 28:106,1980

33. Bjorkmans, Stanski DR, Verotta D et al: Comparitive tissue concentration profiles of fentanyl aand alfentanyl in human predicted from tissue /Blood partition data obtained in rats Anesthesiology 72: 865,1990.

34. Courlay CK, Kowalski SR, Plummer JL et al: Fentanyl blood concentration analgesic response relationship in the treatment of postoperative pain Anesth, Analg 67:329,1988.

35. Shafer SL, Varvel JR: Phrmacokinetics, Pharmacodynamics, and rational opioid selection. Anesthesiology 74:53,1991.

36. Bailey PL, Streis and JB, East KA et al : Differences in magnitude and duration of opioid induced respiratory depression and analgesia with fentanyl and sufentanil Anesth, Analg70:8,1990.

37. Van Akeen H, Meinhausen E et al. The influence of fentanyl and tracheal intubation on the haemodynamic effects of anesthesia induction with propofol/ N₂o in humans. Anesthesiology 68:157,1988.

38. Hug CC, Murphy MR: Tissue redistribution of fentanyl and termination of its effects anesthesiology 55:369,1981

39. Ben-Shlomol et al : Midazolam acts synergistically with fentanyl for induction of Anesthesia. Br. J. Anesth 64:45,1990.

40. Ameer et al : Drug therapy reviews: Evaluation of butorphanol tartrate ; AMJ Hosp. Pharm 36 1683-1691:1979

41. Del Dizzo A, A double-blind study on the effects of butorphanol compared with morphine in balanced anesthesia , Can Anesth Soc J 1978 sep 392-7

42. Vogel sang et al : Butorphanol tartrate relieves post anesthesia shaking more effecteviely than meperidine or morphine J. Post anesth Nurs 1992 Apr 94-100.

43. Anesthesiology 1993 Dec;79(c) 1193-201.

44. Atkinson et al, Double blind comparison of intravenous butorphanol and fentanyl for analgesia during labour; AMJ obstect Gynaecol 1994: 171:1993-8.

45. Palacios QT, Jones MM, et al Post cesarean section analgesia: A Comparison of epidural butorphanol and morphine, Can J Anesth 1991 38: 24-30.

46. Abboud Tk et al, Epidural butorphanol or morphine for the relief of post cesarean section pain ventilatory responses to carbon dioxide, Anest Analg 1987; 66:887-93.

47. Hunt et al; Epidural butorphanol- bupivacaine for analgesia during labour and delivery, Anesth Analg 1989;68:323-7.

48. Heel et al :Drugs 16:473-505 (1978)

49. Vandam L: Drug therapy : Butorphanol. N. Engl J Med 302:381,1980.

50. Heel RC, Brogden RN, Speight TM et al: Butorphanol: A review of its pharmacological properties and theraputic efficacy. Drugs 16:473,1978

51. Lippman M, Mok M S, Stun S N, Caruso FS butorphanol and morphine: a double blind multiple intra muscular dose Comparitive safety and efficacy study in patients with postoperative pain. Curr Ther Res 1977 21 (4):427-434

52. Aitskenhead. A.R. Smith.G. Text Book of Anesthesia. 3^rd edition 1996.

53. Paul. G. Barash, Bruce.F.Cullen, Robert. K. Stoelting Clinical Anaesthesia. 3^rd edition 1997.

54. Ferrante FM, Vade Ban Cover TR . Epidural Analgesia with combination of local anesthetics and opioids. Postoperative pain Management. New York Churchill Livingstone 1993:305-333.

55. J Antonio Aldrete, MDMS, Toruel Campo MD et al Comparison of butorphanol & morphine a Double blind, Randomized study. Anesth Anal 1983:62:78-81

56. Rawal N et al ;Comparison of intra muscular and epidural morphine for postoperative analgesia in the grossly obese. Anaesth, Analg 63:583 1984

57. Behar m, magora F, D Davidson Epidural morphine in treatment of pain Lancet 1979:527

58. Naulty JS, Chantrgian R. Epidural buto-rphanol for post cesarean delivery pain management Anesthesiology 1984 61:415.

59. Bromage PR, Campfeel EM, Nielson CH Rostral spread of epidural morphine Anes, Anal : 1987: 66 :887-93.

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Abstract

Call For Paper Volume 12 Issue 10 November 2024

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Impact Factor SJIF 2024: 7.892

Crossref - DOI

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