A comparative study between butorphanol and tramadol as adjuvant with epidural bupivacaine for post-operative analgesia after pelvi-acetabular surgery

Abstract

Epidural analgesia using local anaesthetic agent is popular simple, effective & economical way of providing postoperative analgesia. In few previous study opioids were added with local anaesthetics, so that even small doses can provide profound analgesia of longer duration with less side effects. We compared the efficacy of epidural butophanol with tramadol as adjuvant with bupivacaine, for postoperative analgesia in view of safety profile among opioids. Sixty patients undergoing pelvi-acetabular surgery were randomly assigned into two groups B & T in double blinded fashion. Group B received 2ml Butorphanol (2mg) & group T received 2ml of tramadol(100mg) as adjuvant with 8ml Bupivacaine (0.125%) as first does. 1ml Butorphanol (1mg) in group B & 1 ml Tramadol(50mg) in group T as adjuvant with 9ml Bupivacaine (0.125%) as subsequent does when VAS>4. Quality of analgesia assessed using VAS for 24hours. Duration of analgesia calculated by time of first analgesia request. Post-operative nausea vomiting & sedation compared. Both butorphanol group & tramadol group provide adequate analgesia but significantly lesser requirement of analgesic doses was observed in the group T compared to Group B. Duration of analgesia in Group B was about 6-7 hour & in Group T was about 8-9 hours. More PONV in Group T & more sedation in group B seen. Therefore, it suggests that epidural bupivacaine with butorphanol has better quality of analgesia in comparison with bupivacaine with tramadol. Although bupivacaine with tramadol has longer duration of analgesia but causes significant nausea & vomiting.