A study of addition of Inj.Butorphanol to hyperbaric Inj.Bupivacaine given intrathecally to patients undergoing lower segment caesarean section: A randomized, controlled trial

• Published in: Medical Journal of Dr. D.Y. Patil University Vol. 6; no. 2; pp. 156 - 160
• Main Authors: Chari, Vangipuram Ranga, Goyal, Anuja, Singh, Vikas
• Format: Journal Article
• Language: English
• Published: Medknow Publications and Media Pvt. Ltd 01.04.2013; Wolters Kluwer Medknow Publications
• Subjects: Injection butorphanol; lower segment cesarean section; Medical research; Medicine, Experimental; post-operative analgesia
• ISSN: 0975-2870
• DOI: 10.4103/0975-2870.110293

Background: Intrathecal 0.5% hyperbaric injection bupivacaine has become increasingly popular as it provides good sensory and motor block for longer duration without any significant neurological side effects. Spinal opiates have been of much interest in recent times as they potentiate the effect of local anesthetic agent and provide longer lasting post-operative analgesia. We compared injection butorphanol and normal saline as an adjuvant to local anesthetic agent in subarachnoid block in lateral position with respect to onset, duration of sensory and motor block and duration of analgesia. Aim: To evaluate the effect of addition of 25 mg of injection butorphanol to hyperbaric injection bupivacaine 0.5% on onset, quality, duration of sensory and motor block, hemodynamic changes, side effects, and post-operative analgesic effect when administrated intrathecally in patients undergoing elective lower segment cesarean section (LSCS). Methodology: Sixty ASA (American Society of Anaesthesiologist) grade-I and II patients scheduled for elective LSCS aged 18-40 years were divided into two equal and comparable groups. The control group represented patients receiving injection bupivacaine 0.5% (10 mg, 2 ml) + 0.5 ml normal saline (total volume 2.5 ml) intrathecally. The study group were the patients receiving injection bupivacaine 0.5% (10 mg, 2 ml) + injection butorphanol 25 mg in 0.5 ml of normal saline (1 mg/ml preservative-free injection butorphanol diluted up to 20 ml by normal saline and 0.5 ml of this solution was taken) making total volume 2.5 ml by intrathecal route. The principle outcome measures were systolic and diastolic blood pressure changes and the anesthetic and analgesic effects. These were summarized and compared between the two groups. Parametric statistics were used to test the null hypothesis of no difference in the two groups. Results: In the early phase of surgery there was more decrease in systolic and diastolic blood pressures in the study group. However, these were of no serious consequence and in the later stages of surgery there was no difference between the two groups. Time to rescue analgesia was delayed in the study group with a mean of 227 min, standard deviation (SD) 13.18 min, compared with the control group, which had a mean of 149.07 min and an SD of 8.19 min. This difference was significant (P < 0.005). Conclusion: Addition of injection butorphanol gives longer duration of post-operative analgesia compared with control without serious side effects.