A COMPARATIVE STUDY OF EPIDURAL BUTORPHANOL AND EPIDURAL FENTANYL FOR THE RELIEF OF POST-OPERATIVE PAIN IN LOWER ABDOMINAL SURGERIES

Abstract

Postoperative pain is acute with complex physiological responses to tissue injury. Epidural
technique using opioids has been found to provide better pain relief than systemic opioids and also decreased incidence of postoperative complications.
AIMS AND OBJECTIVES
The aim of this study was to compare the onset, duration, quality of analgesia, cardio-respiratory effects and side effects of epidural butorphanol with epidural fentanyl for the relief of postoperative pain.
METHODOLOGY
60 patients of either sex, age group of 18- 60 years, belonging to ASA grade Ι and ΙΙ, posted for
elective lower abdominal surgeries were selected. They were randomly divided into 2 groups of 30 each. All surgeries were done under lumbar epidural anaesthesia. Postoperatively, when patient complained of pain, intensity of pain was assessed using Linear Visual analog scale (VAS) and when VAS score was >5, patients received either epidural butorphanol 2mg or epidural fentanyl 100µg diluted to 10ml with normal saline. Onset of analgesia, which is the time interval from administration of study drug till VAS score came down to < 5 was noted in both groups. Duration of analgesia, which is the time interval between start of analgesia (VAS score < 5) till patient complaints of pain (VAS score >5) was noted in both groups. Quality of analgesia was assessed using pain score in both the groups. Cardio-respiratory effects, heart rate, blood pressure and respiratory rate were monitored at regular intervals and were compared between the 2 groups. Side effects like sedation, pruritus, nausea, vomiting, hypotension and respiratory depression were noted.
RESULTS
Demographic profile (age, sex) was comparable in both groups. The onset of analgesia was
clinically and statistically significantly late (6minutes) in butorphanol group when compared to
fentanyl group (3minutes). Duration of analgesia was longer in butorphanol group (350 minutes) in comparison to fentanyl group (230 minutes) which was clinically and statistically significant. Quality of analgesia was better in butorphanol group. Sedation was the main side effect in butorphanol group. Incidence of pruritus, vomiting, hypotension and respiratory depression was more in fentanyl group.
CONCLUSION
Epidural butorphanol provides delayed onset but longer duration and better quality of analgesia than fentanyl with paucity of clinically significant side effects with both groups.