Indian Journal of Anesthesia and Analgesia

Accidental dural puncture is the most common major complication during epidural anaesthesia and causes high risk of post dural puncture headache (PDPH). Intrathecal catherisation in such cases helps in preventing leakage of CSF and thereby decreasing the incidence of PDPH. Here is one such case report of inadvertent intradural puncture during epidural anaesthesia.

Ganglion impar is a solitary ganglion located retroperitoneally at the end of para vertebral sympathetic chain and usually in front of sacrococcygeal joint. Solitary or metastatic tumour in the surrounding tissues causes poorly localized pain. This is a case of 76 year old male, who was diagnosed to have advanced metastatic adenocarcinoma prostate, presented with pain over the lower back radiating to ano rectal region since last 4 months. He had severe pain during defecation which could not be controlled with conventional high-dose opioid application but with transcoccygeal Ganglionimpar chemical neurolysis. We reasoned that blocking the ganglion impar could attenuate this sympathetically maintained pain, which would lead to a reduction in the consumption of opioids, lessen constipation, and lead to an improvement in the patient’s quality of life.

Settings and Design: Study setting: Tertiary care Hospital

Study Design: A Prospective Double Blinded Randomised Clinical Study

Methods and Material: A total of 60 Patients posted for elective lower abdominal surgeries were randomly selected for the study. The patients aged 20-60 years of ASA grade one and two posted for elective lower abdominal surgery were selected for the study. Drugs used were explained to the patients and also educated about Verbal numerical scale for assessment of pain.

Patients were divided into two groups: Group A: receives Butorphanol 1mg mixed with 15 ml Bupivacaine 0.5%diluted upto 20 ml. Group B: receives Fentanyl 100 microgram mixed with 15 ml Bupivacaine 0.5% diluted upto 20 ml.

Statistical analysis used: Statistical data was analysed using • Chi-square test • Student t-test (Paired and unpaired t-test) • A P value of < 0.05 is significant and >0.05 is not significant

Results: The demographic variables were comparable in both groups.

Both inj. Butorphanol 1 mg and Inj. Fentanyl 100 mcg given epidurally with Inj. Bupivacaine 0.5% as a single shot provided excellent operative conditions and satisfactory post-operative analgesia in both the groups. However, the duration of post-operative analgesia was much longer in the butorphanol group than Fentanyl group and was statistically significant. No serious side effects were noted in both groups. The method is economical, safe, convenient and acceptable and also poly pharmacy is avoided.

Conclusions: Both fentanyl and butorphanol are safe and effective as epidural agents for postoperative analgesia with little side effects.