COMPARATIVE STUDY OF POSTOPERATIVE ANALGESIA WITH EPIDURAL TRAMADOL OR BUTORPHANOL IN LOWER ABDOMINAL SURGERIES

Dr. Rumani Ruku and Dr. Akhil Gupta*

ABSTRACT

Introduction: Post-operative analgesia in patients undergoing lower abdominal surgery is very essential for immediate postoperative pain relief which can be provided by oral or parenteral medication, epidural analgesia, local blocks etc. The combined spinal–epidural technique (CSE) has become increasingly popular in recent years. The study was designed to evaluate the efficacy of epidural butorphanol and tramadol for postoperative pain relief. After the surgical procedure and regression of spinal analgesia, the epidural catheter can be used to provide postoperative pain relief. Materials and Methods: After permission from hospital ethics committee, study was conducted on 60 patients undergoing lower abdominal surgeries. Combined spinal epidural anesthesia was planned in all these 60 patients using two segment technique.18 G epidural catheter was placed in L2-L3 space and spinal anesthesia was given at L3-L4 space using 26 G Quincke’s needle and 0.5% bupivacaine 3ml. Sensory, motor block and hemodynamic parameters were monitored intraoperatively. Postoperatively along with hemodynamic parameters visual analogue score (VAS) was observed and at VAS > 4, study drug (either butorphanol 1mg or tramadol 50mg) was given through epidural catheter. Onset of analgesia, quality of analgesia, duration of analgesia, cardio-respiratory parameters and any side effects were monitored and documented. Statistical Analysis: Data analysis was done using the SPSS (Statistical Package for the Social Science) Version 17 for window. Discussion: Mean onset of analgesia in Butorphanol group (10.03 ± 1.85 min) was significantly faster than Tramadol group (12.17 ± 2.19 min) [Z = 4.07, p<0.0001]. Mean duration of analgesia was significantly more in Tramadol group (6.27 ± 0.53 hrs) than with Butorphanol group (3.40 ± 0.42 hrs) [Z=23.06, p<0.0001]. Quality of Analgesia and sedation score was better with Butorphanol group than Tramadol group. Conclusion: Epidural butorphanol provides a rapid, excellent but shorter duration of analgesia when compared to epidural tramadol.

Keywords: Butorphanol, Tramadol, Postoperative analgesia, Epidural analgesia.