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    International Journal of Innovative Science and Research Technology
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    Comparison of the safety and efficacy of butorphanol(2mg ) with 0.2% ropivacaine versus morphine (3mg ) with 0.2%ropivacaine by epidural route for providing postoperative analgesia in patients undergoing below umbilical surgeries.

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    Comparison of the safety and efficacy of butorphanol(2mg ) with 0.2% ropivacaine versus morphine (3mg ) with 0.2%ropivacaine by epidural route for providing postoperative analgesia in patients undergoing below umbilical surgeries.

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    12 views5 pages

    Comparison of Postoperative Analgesic Effects of Epidural Ropivacaine With Butorphanol Versus Epidural Ropivacaine With Morphine in Patients Undergoing Below Umblical Surgeries

    Uploaded by

    International Journal of Innovative Science and Research Technology
    Comparison of the safety and efficacy of butorphanol(2mg ) with 0.2% ropivacaine versus morphine (3mg ) with 0.2%ropivacaine by epidural route for providing postoperative analgesia in patients undergoing below umbilical surgeries.

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    © All Rights Reserved
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    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology

    ISSN No:-2456-2165

    Comparison of Postoperative Analgesic Effects of


    Epidural Ropivacaine with Butorphanol Versus
    Epidural Ropivacaine with Morphine in Patients
    Undergoing below Umblical Surgeries
    Dr. P. Kavitha Sree1, Dr. B. Harikrishna2
    Post Graduate1, Assistant Professor2
    Department of Anaesthesiology,
    Kurnool Medical College, Kurnool,
    Andhra Pradesh

    Abstract:- I. INTRODUCTION
    Background: Comparison of the safety and efficacy of
    butorphanol(2mg ) with 0.2% ropivacaine versus  The International Association for the Study of Pain(
    morphine (3mg ) with 0.2%ropivacaine by epidural IASP) defines pain as an unwelcome emotional and
    route for providing postoperative analgesia in patients sensitive experience associated with factual or implicit
    undergoing below umbilical surgeries. tissue damage or described in terms of similar damage.
     Uncontrolled pain in the postoperative period may
    Methodology: The patients were allotted randomly into 2 produce a range of detrimental acute and chronic effects.
    groups. One group (Group RB) received 0.2% of  Adequate pain control is essential and has been
    Ropivacaine and 2mg of Butorphanol epidurally and recognized as a prime concern for anaesthesiologists.
    another group (Group RM) received 0.2%  Epidural analgesia using local anaesthetics alone or
    Ropivacaineand 3mg of Morphine epidurally. combined with opioids provides adequate pain relief in the
    postoperative period. Combination of opioids to local
    In the postoperative period, when the patients
    anaesthetic solutions placed in the epidural space results
    complained of pain, the intensity of pain was assessed
    in improved analgesia.
    using the VAS scale The pain intensity was assessed by
    VAS score at 0, 15, 30, 60 minutes, 2, 4, 6, 8, 10 and 12 The present study’s primary goal is to assess and
    hours after epidural injection, onset of analgesia, compare the safety and efficacy of epidurally administered
    duration of analgesia, Systolic blood pressure, diastolic butorphanol and morphine as adjuvants with bupivacaine for
    blood pressure, pulse rate, and respiratory rate were postoperative analgesia in below umbilical surgeries.
    recorded at 0, 15, 30, 60 minutes, 2, 4, 6, 8,10 and 12
    hours after epidural injection. SpO2 monitored II. MATERIALS AND METHODS
    continuously.
    The study was conducted in 100 patients of both male
    Results: The average onset time of analgesia of group RB and female sex in the age group of 18-60 years meeting
    was 12.34 ±1.18 minutes and the meantime of onset of ASA class I and II criteria and are undergoing abdominal
    analgesia in group RM was 15.56 ±1.14 minutes. The surgeries electively in Government General Hospital,
    mean duration of analgesia was 251±42.68 minutes in Kurnool.
    group RB and the mean duration of analgesia was 355.4
    ± 68.1 minutes in group RM.  Inclusion criteria
     Patients belonging to the age range of 18 to 60 years
    Conclusion: Butorphanol (2mg) with 0.2% ropivacaine  Both Sex
    provided faster onset of analgesia and shorter duration  Patients of ASA grade I and II
    of analgesia than with morphine(3mg) with 0.2%  Patients undergoing elective infraumbilical surgeries.
    ropivacaine.
     Exclusion criteria
    Keywords:- Epidural, ropivacaine, butorphanol, morphine,
     Patient refusal
    post operative analgesia.
     Patients of ASA grade III, IV and V
     Infection at the site of injection
     Patients with coagulation abnormalities
     Patients with hypersensitivity to local anaesthetics

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    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
    The patients were randomly divided into two group as of the intensity of postoperative pain and were instructed to
    mark on the scale at the point which he she felt was
    GROUP RB: received 0.2% Ropivacaine plus representative of their position of discomfort.
    Butorphanol (2mg),total volume 10ml.  In the postoperative period, when the patients complained
    of pain, the intensity of pain was assessed using the VAS
    GROUP RM (control group): received
    scale. When the VAS score was >5, the study drug was
    0.2%Ropivacaine plus Morphine (3mg), total volume 10ml.
    given through the epidural catheter.
    The patients were explained about the epidural method  P-Value <0.001 was taken as statistically highly
    with the catheter in situ. They were also educated about the significant.
    operation of direct visual analog scale( VAS) for assessment

    III. OBSERVATIONS AND RESULTS

    A. Onset Of Analgesia:
    The mean time of onset of analgesia in group RB was 12.34 ±1.18 minutes, and the meantime of onset of analgesia in group
    RM was 15.56 ±0.1.14 minutes. The onset of analgesia was faster in group RB compared to group RM, and it was statistically
    significant (p<0.05).

    Fig. 1: ONSET OF ANALGESIA

    B. Duration Of Analgesia:
    The mean duration of analgesia was 251.6±42.68minutes in group RB, and the mean duration of analgesia was
    355.4±68.1mintues in group RM. The duration of analgesia was longer in group RM compared to group RB, and it was
    statistically significant (p<0.05).

    Mean duration of group Mean SD p-value


    analgesia (Minutes) <.0.01
    RB 251 42.68
    RM 355.4 68.1
    Table 1: Duration Of Analgesia

    Fig. 2: DURATION OF ANALGESIA

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    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165

    Fig. 3: DBP At Various Time Intervals:

    Fig. 4: Complications

    C. Vas Score: IV. AIMS AND OBJECTIVES


    The mean VAS score forgroup RB and group RM is
    significant at 10 min,15 min and 4 hours with a p A. Aims
    value<0.05. Comparison of the safety and efficacy of
    butorphanol(2mg) with 0.2% ropivacaine vs.
    D. Onset Of Analgesia: morphine(3mg) with 0.2% ropivacaine by epidural route for
    In the present study, the mean time of onset of analgesia providing postoperative analgesia in patients undergoing
    in the group RB was 12.34 ± 1,18 minutes, and in the group, below umbilical surgeries.
    RM was 15.56 ± 1.14 minutes. The difference in the mean
    time of onset of analgesia between the two groups was B. Objectives
    statistically significant, with group RB having the faster  To compare the effectiveness of postoperative analgesia
    onset of analgesia than group RM (12.34 minutes vs. 15.56 with epidural butorphanol with ropivacaine against
    minutes). morphine with ropivacaine.
     To compare associated hemodynamic changes.
    E. Duration Of Analgesia:  To compare side effects like hypotension, bradycardia,
    In the present study, the mean duration of analgesia in nausea, vomiting, pruritis, sedation, shivering, motor
    the group RB was 251.6 ± 42.68min, and in the group, BN, block and respiratory depression
    the mean duration of analgesia was 355.4 ± 68.1min. The  Group RB received Butorphanol(2mg) + 0.2%
    difference in the mean duration of analgesia between the ropivacaine (total volume of 10 ml).
    two groups was statistically significant (p<0.05), with group  Group RM received morphine (3mg) + 0.2%
    RM having a longer duration of analgesia than the group RB ropivacaine (total volume of 10 ml).
    (355.4 ± 68.1min vs. 251.6 ± 42.68min).

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    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165
    The following parameters were observed.
     Stastisticalanalysis :
    The pain intensity was assessed by VAS score at 0, 15,  In this study, 100 patients were made into 2 groups,
    30, 60 minutes, 2, 4, 6, 8,10 and 12 hours after epidural each comprising of 50 patients.
    injection if patient complains of pain even after epidural  Continuous variables were represented as mean and
    injection intensity is assessed with VASscore and If it was standard deviation where data follows a normal
    >5, a non-opioid analgesic was given. distribution, otherwise as median with range.
     Categorical variables were represented as frequencies
    and percentages.
     The statistical significance of the difference in the
    outcome variables between the groups was assessed by
    the Chi-Square test, Fisher’s exact test, and t-test.
     Onset of analgesia:  P-Value <0.05 was taken as significant statistically.
    The time interval from the administration of the study
    drug till the VAS score came down to <5.  VAS Score:
    In group RB, the mean VAS scores at 0 min, 15 min,
     Duration of analgesia:
    30 min, 60 min, 2 hrs, and 4 hrs were 8.26±1.64, 6.6±1.22,
     The time interval between onset of analgesia, till patient 0.96±0.7, 0.58±0.67, 1.02±0.65, and 1.26±0.69. In group
    complained of pain (VAS score >5) when rescue RM, the mean VAS scores at 0 min, 15 min, 30 min, 60 min,
    medication was given. 2 hrs, and 4 hrs were 7.42±1.41, 6±1.41, 0.78±0.70,
     Systolic blood pressure, diastolic blood pressure, pulse 0.36±0.52, 0.78±0.64, and 0.8±0.75. VAS scores for group
    rate, and respiratory rate were recorded at 0, 15, 30, 60 RB and RM is significant at 15 mintues and 4 hours with p
    minutes, 2, 4, 6, 8,10 and 12 hours after epidural value <0.05.
    injection. SpO2 monitored continuously.
     Side effects like pruritis, nausea, vomiting, hypotension,
    bradycardia, sedation, motor block, shivering, and
    respiratory depression was recorded in both groups.

    Mean time of Group Mean(min) SD p-value


    onset of analgesia RB 12.34 1.18
    RM 15.56 1.14 <0.01
    Table 2: VAS SCORE

    Fig. 5: VAS Score

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    Volume 8, Issue 1, January – 2023 International Journal of Innovative Science and Research Technology
    ISSN No:-2456-2165

    Fig. 6: SBP at Various Time Intervals:

    V. CONCLUSION [4.] Kumar M, Suwalka U, Kumar H, Ankita. Comparison


    of epidural butorphanol versus nalbuphine as
    From our study, we conclude thatButorphanol adjuvants with bupivacaine for abdominal
    (0.04mg/kg) with 0.2% ropivacaine provided faster onset of hysterectomy: A prospective randomized, double-
    analgesia than with morphine(0.06mg/kg) with 0.2% blind controlled clinical study. Global
    ropivacaine. [5.] Journal for research analysis. 2018;7(5). DOI:
    10.36106/gjra.
    Morphine(0.06mg/kg) with 0.2% ropivacaine provided
    a longer duration of analgesia than with
    butorphanol(0.04mg/kg) with 0.2% ropivacaine.

    From the present study, we concluded that butorphanol


    as additive to epidural ropivacaine provides a rapid,
    excellent analgesia with shorter duration when compared to
    epidural ropivacaine with morphine. nausea, vomiting,
    pruritus and hypotension are common with morphine as
    additive to epidural ropivacaine where as sedation was seen
    more commonly when butorphanol is used as additive.in
    view of safety profile,epidural ropivacaine in the treatment
    of postoperative pain for below umbilical surgeries
    .however, continuous monitoring is required.

    REFERENCES

    [1.] Babu S, Gupta BK, Gautam GK. A comparative study


    for post operative analgesia in the emergency
    laparotomies: Thoracic epidural ropivacaine with
    nalbuphine and ropivacaine with butorphanol. Anesth
    Essays Res. 2017;11:155-9.
    [2.] Sharma S, Naik S, Jamale PB, Dhulkhed VK,
    Prasoon A. A comparison of epidural butorphanol
    2mg and fentanyl 75 mcg for postoperative analgesia
    using combined spinal epidural anaesthesia
    technique: A randomized doubleblind clinical study.
    IJMHR. 2018;4(4):97-101.
    [3.] Chakravarthy NN, Sagar A, Venkateshwarlu G. A
    comparative study of epidural 0.5% bupivacaine with
    nalbuphine and .5% bupivacaine with fentanyl in
    lower abdominal and lower limb surgeries. IAIM.
    2018;5(2):124-134.

    IJISRT23JAN1309 www.ijisrt.com 2505

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