Abstract
Introduction: A pain free post-operative period is a boon to mother for caring the neonate .Spinal anesthesia is most preferred technique for caesarean section. Spinal opiates as adjuvants potentiate effect of local anesthetics and give prolonged postoperative analgesia.
We evaluated the effect of addition of 25 mcg of injection butorphanol to hyperbaric injection bupivacaine 0.5% on hemodynamic changes neonatal outcome and post-operative analgesia in patients undergoing elective lower segment caesarean section (LSCS).
Methodology: After obtaining ethical committee clearance and patient consent a double blinded prospective RCT was conducted between July2016- Feb2017. 60 ASA grade-I and II patients were divided into two equal groups. Group A(n=30) patients received injection hyperbaric bupivacaine 0.5%1.8 ml + injection butorphanol 25 mcg in 0.5 ml normal saline (NS) and Group B (n=30) received injection hyperbaric bupivacaine 0.5%1.8 ml + 0.5ml NS making total volume 2.3 ml by intrathecal route .
The principle outcome measures were onset, duration of sensory and motor block, hemodynamics, apgar scores and duration of postoperative analgesia. Study groups were analysed using chi-square test. P-Value by SPSS software.
Results: Duration of analgesia was significantly better in group A (264.16 min vs 141.36min) Hemodynamics and Apgar scores showed no statistical significance in both groups.
Conclusion: Intrathecal butorphanol gives longer duration of post-operative analgesia without compromising neonatal scores and maternal hemodynamics.
Keywords: Bupivacaine, Butorphanol, Caesarean ,Spinal.
References
- Sukhani R, Stevens RA. Spinal anesthesia. In: Benzon HT, Raja SN, Borsook D, Molloy RE, Strichartz G (eds). Essentials of Pain Medicine and Regional Anaesthesia, New York: Churchill Livingstone 1999; pp350-7.
- Chu CC, Shu SS, Lin SM, Chu NW, Leu YK, Tsai SK, et al. The effect of intrathecal bupivacaine with combined fentanyl in cesarean section. ActaAnaesthesiol Sin 1995;33:149-54.
- Courtney MA, Bader AM, Hartwell B, Hauch M, Grennan MJ, Datta S. Perioperative analgesia with subarachnoid sufentanil administration. RegAnesth 1992;17:274-8
- Wang C, Chakrabarti MK, Whitwam JG. Specific enhancement by fentanyl of the effects of intrathecal bupivacaine or nociceptive afferent but not on sympathetic efferent pathway in dogs. Anesthesiology 1993; 79: 766-73.
- Lawhorn CD, McNitt JD, Fibuch EE, Joyce JT, Leadley RJ. Epidural morphine with butorphanol for postoperative analgesia after caesarean delivery. Anaesth Analg. 1991;72:53-7
- Chari VRR, Goyal AA, Singh V. A study of addition of injection butorphanol to hyperbaric injection bupivacaine given intrathecally to patients undergoing lower segment caesarean section: a randomized controlled trial. Med J of Dr. DY Patil Univ. 2013;6(2):156-60.
- Kaur M, Katyal S, Kathuria S, Singh P. A comparative evaluation of intrathecal bupivacaine alone, sufentanil or butorphanol in combination with bupivacaine for endoscopic urological surgery. Saudi J Anaesth. 2011;5:202-7..
- Dyer RA, Joubert IA – Low-dose spinal anaesthesia for Caesarean section. CurrOpinAnaesthesiol, 2004;17:301-308.
- Karaman S, Kocabas S, Uyar M et al. – The effects of sufentanil or morphine added to hyperbaric bupivacaine in spinal anaesthesia for caesarean section. Eur J Anaesthesiol, 2006;23:285-291.
- Braga AFA, Braga FSB, Potério B et al. – Sufentanil added to hyperbaric bupivacaine for subarachnoid block in Caesarean section. Eur J Anaesthesiol, 2003;20:631-635.
- Bogra J, Arora N, Srivastava P – Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for Cesarean section. BMC Anesthesiology, 2005;5:5.
- Simon L, Boulay G, Ziane AF et al. – Effect of injection rate on hypotension associated with spinal anesthesia for cesarean section. Int J ObstetAnaesth, 2000;9:10-14.
- Gear, RW; Miaskowski C, Gordon NC, Paul SM, Heller PH, Levine JD "The Kappa Opioid Nalbuphine Produces Gender- And Dose-Dependent Analgesia AndAntianalgesia In Patients With Postoperative Pain". Pain83 (2): 339–45.
- Gunion MW, Marchionne AM, Anderson CTM. Use of the mixed agonist-antagonist nalbuphine in opioid based analgesia. AcutePain 2004;6:29-39.
- Tiwari CS, Agnihotri VM. Intrathecal pentazocine 1.5mg/kg, produced sufficient analgesia and motor block in 60 patients undergoing various surgical procedures below umbilicus. Indian J Anaesth 1997;40:30-6.
Corresponding Author
Dr Ramachandra Badami
Dept of Orthopedics, Subbaiah Institute of Medical Sciences,
Purle, NH-13, Shimoga-577222, Karnataka, India
Mob: 9844061476, Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v5i12.155
