Title: Comparison of Post Cesarean Analgesia with Epidural Bupivacaine-Fentanyl v/s Bupivacaine-Nalbuphine v/s Bupivacaine-Butorphanol – A Double Blinded Randomized Study
Authors; A Karthik, Satish Logidasan, Arulraj G.P, R Kanimozhi, A Gowri Shankar, S Prasana Vathanan, Ambal S, C Sathish, S.R. Karthick
DOI: https://dx.doi.org/10.18535/jmscr/v7i2.176
Abstract
80 ASA physical status I and II women, aged 20-30 years, undergoing Elective Cesarean Section were included in the study. Patients were randomly allocated to four groups during the postoperative period to receive one of four epidural regimens: Group 1(NS): 10ml of 0.125% Bupivacaine + 1ml of Normal Saline; Group 2(FENT) 10ml of 0.125% Bupivacaine + 50ug of Fentanyl (1ml); Group 3(NALB) 10ml of 0.125% Bupivacaine + 5mg of Nalbuphine (0.5ml) +0.5ml of Normal saline to make it into 1ml; Group 4 (BUTOR): 10ml of 0.125% Bupivacaine + 1mg of Butorphanol (1ml).
Onset and duration of analgesia were recorded. Hemodynamic variables, pain scores, sedation scores, and respiratory rate were monitored for 24 hours. Frequency and severity of respiratory depression, sedation, pruritus, nausea, and vomiting were recorded. The mean onset of analgesia and times to reach peak analgesia were significantly shorter while the mean durations of analgesia were significantly longer in the groups receiving fentanyl, nalbuphine & butorphanol than in the group receiving bupivacaine alone. The onset of analgesia was earliest with Butorphanol group. The duration of analgesia was maximum with Butorphanol group. None of the patients developed hypotension, Bradycardia, respiratory depression.
Epidural 0.125% Bupivacaine combined with Butorphanol produces significantly earlier onset, longer duration and better quality of analgesia than 0.125% Bupivacaine - Nalbuphine combination / 0.125% Bupivacaine -Fentanyl combination / 0.125% Bupivacaine alone and is safe in parturients.
References
- Abboud TK, Afrasiabi A, Zhu J, Mantilla M, Reyes A, D'Onofrio L, et al. Epidural morphine or butorphanol augments bupivacaine analgesia during labor. Reg Anesth 1989;14:115-20.
- Shrestha CK, Sharma KR, Shrestha RR. Comparative study of epidural administration of 10 ml of 0.1% bupivacaine with 2 mg butorphanol and 10 ml of 0.25% plain bupivacaine for analgesia during labor. J Nepal Med Assoc 2007;46:1-6.
- Pokharel K, Rahman TR, Singh SN, Bhattarai B, Basnet N, Khaniya S.et al; JNMA J Nepal Med Assoc. 2008 Apr-Jun;47(170):57-61.
- Gupta R, Kaur S, Singh S, Aujla KS. A comparison of epidural butorphanol and tramadol for postoperative analgesia using CSEA technique. J Anaesthesiol Clin Pharmacol 2011;27:35-8
- Baxter AD, Laganiere S, Samson B, et al. A dose-response study of nalbuphine for postthoracotomy epidural analgesia. Can J Anaesth 1991.
- Pugh GC, Drummond GB. A dose-response study with nalbuphine hydrochloride for pain in patients after upper abdominal surgery. Br J Anaesth 1987;59:1356-63.
- Hunt co, datta s, ostheimer gw. Epidural butorphanol-bupivacaine for analgesia during labor and delivery. Anesth Analg 1989;68:323-7.
- Cohen SE, Subak LL, Brose WG, Halpern J. Analgesia after cesarean delivery: patient evaluations and costs of five opioid techniques.Reg Anesth 1991;16:141–9.
- Naulty JS, Weintraub S, Mcmahon J, Ostheimer GW, Hunt C, Chantigian R. Epidural butorphanol for post cesarean delivery pain management. Anesthesiology 1984;61:A415.
- Wittels B, Glosten B, Faure EA, Moawad AH, Ismail M, Hibbard J, et al. Opioid antagonist adjuncts to epidural morphine for postcesarean analgesia: Maternal outcomes. Anesth Analg 1993;77:925-32.