COMPARATIVE STUDY OF EPIDURAL BUTORPHANOL AND EPIDURAL TRAMADOL FOR POST OPERATIVE ANALGESIA

Abstract

Introduction: Postoperative pain may raise various psychological and physiological phenomenon that effective pain control vital for early mobilization and postoperative discharge. In major surgeries cases, Postoperative analgesia is the most important aspect of anesthesia. In such cases which cause severe pain which if treated inadequately causes atelectasis of lungs, shallow breathing.  Hence secretions of retention and more time will be required in ambulation. This may increases incidence of postoperative morbidity which leads to delayed recovery. Using local anesthetic agent as Epidural analgesia is popular simple, effective and economical way of providing postoperative analgesia. opioids have been added due to short duration of local anesthetic so that even small doses can provide extreme  analgesia of good duration with less side effects. With addition of opioids in Local anesthetics increase the duration of analgesia reducing frequent supplementation of drugs. Therefore there is less frequency of systemic side effects and reduction in dosage attributable to each.  Pethidine and Morphine remain the standard opioids which are used for postoperative pain. However they are related with delayed respiratory depression and abuse potential. Mixtures of agonistantagonist opioid and tramadol hydrochloride a moderately potent opioid agonist have been used in both for this purpose separately in few studies. 

Aim of study: The main objective of this study is to the effectiveness of butorphanol and tramadol as postoperative analgesics.

Material and Methods: The present study was carried out in the department of anaesthesia at Prakash Institute of Medical Science and Research Urun-Islampur Maharashtra. All patients which undergoing surgeries were included in this study. Total 60 paediatric patients were included in this study with the age range from 15 years to 60 years. Aseptic precautions were taken to the patients when epidural needle was introduced and space identified using loss of resistance to air technique. spinal anaesthesia were given to all patients for the surgical procedure one space lower than the insertion site of epidural catheter using 25G spinal needle and 2.5-3ml of heavy bupivacaine 0.5% was given. Sensory and motor effects were also checked.

Result: According to age, sex, sensory level attain during spinal anaesthesia and duration of surgery where two groups were compared. Among postoperative parameters mean systolic and diastolic blood pressure and pulse rate decreased significantly (p<0.05) when compared with the time intervals during 0 hours and 24 hour period in both the groups, however on intergroup comparison the difference was not found statistically significant (p>0.05). Mean duration of analgesia was significantly higher (p < 0.05) in group II when compared with 2mg butorphanol. Out of 30 patients in group II 3patients Nausea and vomiting was seen which was found significant statistically from group I i.e. butorphanol group where no patient had such problem. Out of 30 patients in group I (butorphanol) 27 patients and 15 patients from group II (tramadol) had sedation which was highly significant.

Conclusion: Epidural butorphanol has better quality of analgesia (VAS) as compared to tramadol in which shorter duration and sedation are major disadvantages. Although Butorphanol has shorter duration of analgesia but has better pain relief as compared to tramadol. Therefore more prospective studies are required in order to recommend any drug as useful supplement for increasing post operative analgesia.

Keywords: Post-operative, Pain, Epidural, Butorphanol, Tramadol