Comparison between Fentanyl and Butorphanol as Epidural Adjuvants in Combined Spinal Epidural Anesthesia for Lower Limb Surgeries - A Prospective, Randomized Control Trial
Sangeetha Gunasekaran Govindaswamy, Robin Sajan Chacko, Krishna Prasad Thangarasu, Soundarya Priyadarshini KalaiselvanAbstract
Background and Aim:
Additives are drugs that, when used with local anesthetic which increase the efficacy or potency of the action of other drugs. The purpose of this study was to improve the quality and duration of analgesia along with the dose-sparing effect with local anesthetics. We evaluated the quality, duration of analgesia, sedation, adverse effects, and hemodynamic stability of epidurally administered fentanyl and butorphanol when combined with bupivacaine.
Materials and Methods:
This study was a prospective, randomized control study conducted among 46 patients undergoing elective and emergency lower limb surgery with combined spinal-epidural (CSE) anesthesia with bupivacaine. They were divided into two groups receiving either fentanyl or butorphanolas adjuvants. Hemodynamic parameters were monitored intraoperatively and postoperatively. Sedation score, pain score, and time interval for the rescue analgesia were observed.
Results:
The butorphanol group had better hemodynamic stability (pulse rate, systolic blood pressure (BP), diastolic BP, mean arterial pressure, and respiratory rate), significantly lower pain scores, and significantly higher mean time for the requirement of rescue analgesia while fentanyl provided adequate sedation. Nausea was reported in some cases among the butorphanol group.
Conclusion:
Considering the hemodynamic stability and reduced pain scores, butorphanol can be preferred over fentanyl as an adjuvant to bupivacaine in CSE anesthesia.