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Comparative Evaluation of Butorphanol Versus Nalbuphine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries

Haramritpal Kaur , Mukesh Kumar1 , Amit Kumar Lal2 , Haramritpal Kaur3 , Gurpreet Singh4 , Naresh Baghla5 , Harmanpreet Kaur Jhand6

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Indian Journal of Anesthesia and Analgesia 6(2):p 611-618, MARCH-APRIL 2019. | DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6219.37

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Mukesh Kumar, Amit Kumar Lal, Haramritpal Kaur. Comparative Evaluation of Butorphanol Versus Nalbuphine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries. Indian J Anesth Analg. 2019;6(2):611-618.

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Abstract

Background: Epidural opioids acting through the spinal cord receptors improve the quality and duration of analgesia along with dose-sparing effect with the local anesthetics. The present study compared the efficacy and safety profile of epiduraly administered butorphanol and nalbuphine combined with ropivacaine. Materials and Methods: A total of 60 adult patients of either sex of American Society of Anesthesiologist physical status I and II, aged 18-60 years, undergoing lower limb orthopaedic surgeries under combined spinal epidural anaesthesia were enrolled into the study. Patients were randomly divided into three groups of 20 each: 0.2% Ropivacaine (group 1), 0.2% ropivacaine + 2 mg butorphanol (group 2), 0.2% ropivacaine + 10 mg Nalbuphine (group 3). The hemodynamic parameters as well as onset of pain relief and duration of analgesia were noted. Adverse events and sedation scores were also noted. Results: We found that haemodynamics were comparable in all the three groups. Onset of analgesia was earliest in Nalbuphine group (group 3) 1.45±0.51 min) followed by butorphanol group - group 2 (4.45±0.61 min) and maximum in ropivacaine plain group 1(8.30±0.97 min. The duration of analgesia was significantly prolonged in group 3 (6.40±0.821 hr) followed by butorphanol group - group 2 (4.45±0.605 hr) and shortest in plain group - group 1 (2.30±0.470 hr). Sedation was observed markedly in butorphanol group. No serious cardio respiratory side effects were observed in any group. Conclusions: Butorphanol and Nalbuphine as epidural adjuvants are equally safe and provide comparable stable hemodynamics, early onset and establishment of sensory anesthesia. Nalbuphine provides a significantly prolonged post-operative analgesia.

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Mukesh Kumar, Amit Kumar Lal, Haramritpal Kaur. Comparative Evaluation of Butorphanol Versus Nalbuphine for Postoperative Epidural Analgesia in Lower Limb Orthopaedic Surgeries. Indian J Anesth Analg. 2019;6(2):611-618.

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DOI: http://dx.doi.org/10.21088/ijaa.2349.8471.6219.37

Keywords

Ropivacaine; butorphanol; epidural anesthesia; nalbuphine; lower limb orthopaedic surgery.

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