A comparison between epidural Butorphanol and Tramadol for postoperative analgesia, sedation and side effects using CSEA technique for surgeries below the level of umbilicus

Abstract

Background and Aims: Epidural analgesia using low doses of local anesthetic agent with or without adjuvants like opioids is a popular, simple, effective and economical way of providing postoperative analgesia. We proposed to evaluate and compare the efficacy of epidural opioids, Butorphanol and Tramadol using Combined Spinal Epidural Analgesia (CSEA) technique for surgeries below the level of umbilicus for postoperative analgesia, sedation and side effects. Methods: In this prospective, double blind, randomized controlled clinical trial, 60 patients aged 18 to 60 years, ASA grade 1 or 2 posted for planned elective surgery below the level of umbilicus were selected. Study Design: The patients were randomly allocated into 2 groups to receive postoperatively either 1 mg of inj. Butorphanol (dissolved in 10 ml of normal saline) (Group B ) or 50 mg of inj. Tramadol (dissolved in 10 ml of normal saline) (Group T ) epidurally as a bolus dose when the VAS score for pain was more than 4 after the conclusion of surgical procedure as the effect of spinal anaesthesia started wearing off. Statistics and Results: The mean duration of analgesia with tramadol (group T) 6.481 ( 0.86842) hrs. was significantly higher than with butorphanol (group B) i.e., 5.352 (0.33258) hrs with a p value of 0.0001. Pain scores were also significantly lower statistically in group B as compared to group T. Sedation scores were significantly higher in group B than group T, which was statistically highly significant (p= 0.0001). Conclusion: Both epidural, butorphanol and tramadol provided good postoperative analgesia. The duration of analgesia was longer with tramadol, quality of analgesia was better with butorphanol, sedation more with butorphanol as compared to tramadol and other side effects were comparable.