Comparison of butorphanol and fentanyl for balanced anaesthesia in patients undergoing laparoscopic surgeries under general anaesthesia:A prospective, randomized and double-blind study

Abstract

INTRODUCTIONPain is an unpleasant sensation, which produces a reaction consisting of withdrawal response, metabolic response, hormonal response and conscious aversion. The side-effects of pain include peripheral vasoconstriction, reduced functional residual capacity and reduced sputum clearance.1,2 Pain relief has many advantages, namely, reduction in metabolic response to trauma, there by prevent postoperative negative nitrogen balance. Moreover pain-free patients have better mobility with immediate benefits in reduced incidence of chest infections and deep vein thrombosis. Laparoscopy has been promoted aggressively and has advantages like shorter hospital stay, more rapid return to normal activities, less pain associated with the small, limited incisions and less postoperative ileus compared with the open laparotomy technique.3,4 Pneumoperitoneum causes various cardiovascular and respiratory derangements. The purpose of this study was to compare equipotent moderate doses of two different analgesics i.e., butorphanol and fentanyl in healthy adult patients undergoing laparoscopic cholecystectomy and appendicectomy under general anaesthesia in terms of intra-operative haemodynamics and post-operative pain relief. MATERIAL AND METHODSThis prospective, randomized and double-blind study was conducted after obtaining approval from the Institutional Ethical Committee to compare the analgesic efficacy of equipotent moderate doses of butorphanol and fentanyl in patients undergoing laparoscopic surgeries under general anaesthesia. ABSTRACTBack ground: Laparoscopic surgeries have advantages like shorter stay and rapid return to normal activities because of small incision and les pain. Pain is an unpleasant sensation in the post-operative period. Methods: Fifty patients of American society Anesthesiologists (ASA) grade I and II, scheduled to undergo laparoscopic surgery, were randomized into butorphanol group (Group B) (n=25) and fentanyl group (Group F) (n=25). Four minutes before induction of anesthesia, Group B received inj. butorphanol 40 µg/Kg intravenously while Group F received Inj. fentanyl 2 µg/kg intravenously. All patients received general anaesthesia with controlled ventilation. Heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), end tidal carbon dioxide (ETCO 2 ), and oxygen saturation were monitored at different intervals. Results: The demographic data was comparable in both groups (p<0.05). There was a significant difference between the two groups in pulse rate after 12 minutes after intubation that persisted till the 2 nd hour of post-operative period. There was no significant difference in DBP till 9 min after intubation, and then onwards significant changes were noted till 4 th hour of post-operative period. Butorphanol provided prolonged analgesia when compared to fentanyl. Conclusions: We conclude that butorphanol is a better alternative to fentanyl for use as analgesic in laparoscopic surgeries because of its ability to produce prolonged analgesia, and less post-operative compli...