Butorphanol-bupivacaine versus Fentanyl-bupivacaine for Extradural Analgesia during Labour

Abstract

Original Article IntroductionT he control of pain should forms an integral part of the management of labour, yet pain relief in labour is a controversial subject. Pregnant woman have a right to basic information about pain and its relief in labour. Labour analgesia, is rapidly catching up in the Armed Forces, and it would still be a while, before all women in labour are offered this service. Amongst the various modalities of pain relief in labour, epidurals have gained popularity. The aim of this study was to compare a relatively less utilised opioid, butorphanol with the timetested fentanyl in epidural labour analgesia. MethodThe study was approved by our hospital ethics committee and informed consent was obtained from each patient. 64 women with American Society of Anaesthesiologists physical status I and II, between the ages of 18 and 40 years who opted for epidural labour analgesia were enrolled. Participants had singleton pregnancy of greater than 36 weeks of gestation with vertex presentation. All women were in active labour with cervical dilatation of 3 to 5 cm at the time of epidural catheter placement. The women had a pre dose Visual Analog Score (VAS) for labour pain of ≥ 30mm measured on two occasions, when two consecutive uterine contractions occurred.Patients with known hypersensitivity to local anaesthetics, neurologic, neuromuscular or psychiatric disorders, blood dyscrasias, weight greater than 110 kg, height less than 144 cm, cephalopelvic disproportion, known foetal abnormalities or multiple pregnancy were excluded from the study.Randomisation was done by the toss of a coin and patients were allocated to two groups. The first group (n=32) received 15ml of 0.1% bupivacaine with 0.1mgml -1 butorphanol (1.5mg) and the second group (n=32) received 15ml of 0.1% bupivacaine with 2μgml -1 of fentanyl. The patient and anaesthesiologist were blind to the drug combination, which was prepared by a trained assistant.All patients were started on an intravenous infusion of ringer lactate. An 18 gauge epidural catheter was placed 3 to 4 cm inside the epidural space via an 18-gauge Tuohy epidural needle at the L2-3 or L3-4 level. If there was any evidence of entry into an epidural vein or cerebrospinal fluid the patient was excluded from the study. After negative aspiration, a bolus of 15 ml of either drug was given over 5 minutes. A test dose was omitted.The efficacy of the drug was assessed using a 100 mm visual analogue scale, where 0 represented no labour pain and 100 represented the worst possible pain, at five minute intervals and during contractions for the first 20 min, at 20 minute intervals for the first hour, at 30 minute intervals for the next hour, and hourly thereafter, till the end of labour or when patient complained of pain. -1 of fentanyl. Results: The times of onset and offset of analgesia were comparable. More patients of the butorphanol group were sedated but arousable. The patient satisfaction levels were good in both groups and APGAR scores were comparable. Conclusion: Butorphanol and fe...

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

“…However more patients were calmed in the butorphanol bunch. 23 The outcome is against the utilization of butorphanol as adjuvant for post employable absense of pain.…”

Advances in the Use of Butorphanol Tartrate in Postoperative Analgesia after Cesarean Section

“…Satisfactory analgesia after caesarean section can be obtained with epidural administration of butorphanol tartrate alone, which has a rapid onset of action and is more analgesic than morphine, although the duration of action is limited [50] . When buprenorphine is used as an epidural adjuvant in combination with bupivacaine, the onset of analgesia is significantly shorter, duration and quality of analgesia are significantly improved, and the incidence of adverse events such as respiratory depression, nausea and vomiting, and itching is low, as compared to the drug alone [51 . Butorphanol tartrate, when used as a continuous epidural pumping drug in post-caesarean section and labour analgesia, not only obtains a more stable and long-lasting analgesic effect, but also does not produce motor blockade, which can be safely and effectively applied to maternal post-caesarean section analgesia [52,53] .…”

Safety and effectiveness of butorphanol in epidural labor analgesia: A protocol for a systematic review and meta-analysis

“…Butorphanol is a lipid-soluble narcotic that has modest agonistic and antagonistic effects as well as significant κ-receptor agonism. Butorphanol, which has a strong visceral component, has been proposed to be effective at reducing pain during labor because κ-receptors appear to be involved in visceral pain regulation[ 5 - 10 ]. However, no study has comprehensively examined the safety and efficacy of using butorphanol as an epidural analgesic during labor.…”