European Journal of Cardiovascular Medicine

Introduction:  Butorphanol   is a   synthetic opiod agonist on   κ (kappa)     receptor   and antagonist   or partial agonist on   μ (mu) receptor.  Epidural   Butorphanol   has   been   used   successfully for post operative pain relief.   It is  safer  than  pure   agonist   opioids  because   of   its  ceiling   effect   on  respiratory    depression,  lower  addiction   potential,  lesser  nausea , vomiting,   pruritus  and  also   produces   sedation .  Nalbuphine   is   antagonist of μ   and   κ receptor   agonist. Aims and  Objectives : To    compare   the   effects   of   Butorphanol   and    Nalbuphine    with   Bupivacaine  given in   epidural   route   as  adjunct  to   spinal  anesthesia   in  infraumbilical  gynecological surgeries   for   post   operative   analgesia.  Materials and Methods: This study was done in Department of Anesthesiology of M.K.C.G Medical College from June 2021 to August 2022, Berhampur, Odisha; India. Total of 80 female patients of age 15- 50 years of ASA grading I & II were scheduled for elective gynecological surgeries under combined spinal and epidural anesthesia(CSE).  On the day of surgery the selected cases were randomly placed into two groups of 40 each; Group-B: received 10 ml of 0.125% Bupivacaine+1ml(1mg) of butorphanol and Group-N: received 10 ml of 0.125% Bupivacaine+1ml(10mg) of Nalbuphine. Operation was allowed after achievement of block height up to T8. After 2 segment regression of block height i.e T8 to T10, total amount of drug studied were injected to group-B and group-N respectively. Vital parameters such as heart rate, BP, respiratory rate and SpO2 were monitored every 5 minutes for next 30 min, every 30 min for next 2hrs and 2hrly for next 12hrs postoperatively. Onset time, duration and quality of analgesia was recorded using visual analogue score (VAS) and compared in two groups.  Results:  No significant difference in  mean heart rate(MHR) from 0 minutes to 360  minutes  between  both  the groups  B and  N. MHR in group-B  was  83.65/min and  group-N  was  80.40/min  at 480 minutes(p =0.02)  which is statistically significant. Mean Arterial Pressure (MAP) of both the groups are comparable from 0 to 240mins and are not statistically significant but p-value of MAP in 360 and 480 mins was < 0.05 and this change is blood pressure might be due to onset of pain between 120 to 240mins in group-N and 360 to 480 mins in group B. The mean onset of analgesia was 6.20 minutes and 6.50 minutes in group-B and group-N respectively. The mean duration of analgesia was 398.45 minutes in Group B and 222.88 minutes in Group N. The duration was significantly longer in butorphanol group. Among all, 37 cases (92.5%)  and 38 cases(95%) have good pain score on evaluation after 30minutes of administration of epidural drug which is statistically significant followed by 3 cases(7.25%) and 2 cases(5%) have fair pain score  from group-N and group-B respectively. Sedation as side effects found in 85% and 50% of cases butorphanol and nalbuphine group respectively. Current study shows that 10% of cases in group-B and 5% cases in group-N had nausea and vomiting, which is major side effect of nalbuphine group. No patients in nalbuphine group and butorphanol group had pruritus in this study.  Conclusion: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of post-operative pain relief. Epidural Butraphanol  in a dose of 1mg with 0.125% bupivacaine, provides  longer duration of analgesia with better pain score and more sedation which is  advantageous for post operative patient as compared to 10 mg of  Nalbuphine with 0.125% bupivaine.