Comparison of two different doses of Epidural Butorphanol in Lower Limb Orthopedic Surgery

Abstract

Introduction: Epidural and spinal anaesthesia both are effective alternative to general anaesthesia when surgical site is located in lower extremities. When post operative analgesia is required epidural anaesthesia is the choice. This study was conducted to assess the effect of Butorphanol added to local anaesthetic via epidural route and to optimize the dose of Butorphanol via epidural route i.e. 2mg and 3 mg and to observe the duration of postoperative analgesia with two different doses. Methodology: A randomized control study was conducted on 40 ASA I & II patients of either sex aged 18-60 yrs undergoing lower limb orthopedic surgery under epidural anesthesia. The patients were randomly allocated into two equal groups. Group A received 2 mg of Butorphanol along with local anaesthetic solution and Group B received 3mg of Butorphanol along with local anaesthetic. The onset and peak effect of sensoryand motor block, level of sedation, hemodynamic changes and duration of postoperative analgesia and complications, if any were observed. Results: For sensory effect, onset was 25±7.07 sec and peak effect 312.5±12.4 sec in Group A patients as compared to Group B where it was 12.81±21.68 sec and 162.8±21.68 sec respectively, which is statistically significant (P<0.05). For motor effect onset was 3.5±1.01 min and peak effect 11.4±3.91 min in Group A patients as compared to Group B patients where it was 2.7±0.67 min and 6.09±0.97 min (P<0.05). Hemodynamics remained stable and comparable in both the groups (P>0.05). Duration of postoperative analgesia according to VAS, pain relief in Group A patients was up to 8 hrs and in Group B it was up to 12 hours and rescue analgesia required only after 12hrs (P<0.05). Conclusion: Newer synthetic opioid-Butorphanol can be used along with local anaestheticsolution via epidural route in lower limb surgeries with effective intraoperative sedation and prolonged postoperative analgesia without fear of nausea/vomiting and respiratory depression.