A study of safety and efficacy of analgesia and anaesthesia between intrathecal fentanyl and butorphanol as adjuvants with bupivacaine 0.5% heavy for lower limb orthopedic surgeries

Abstract

Aims: The aim of the study is to compare the safety and efficacy of anaesthesia and analgesia between intrathecal fentanyl and butorphanol as adjuvants with bupivacaine 0.5% heavy for lower limb orthopaedic procedures. Materials and methods: Eighty patients of ASA grade I and II of either sex in the age group of 18 to 50 years scheduled for elective lower limb orthopaedic procedures were allocated randomly into two groups of 40 each. Group A received intrathecal inj 0.5% heavy bupivacaine 2.5ml with 0.5ml inj fentanyl 25mcg while patients in group B received intrathecal inj 0.5% heavy bupivacaine 2.5ml with 0.5ml inj butorphanol 25mcg. Intra-operative hemodynamic parameters (HR, SBP, DBP,MAP, RR, SPO2) were noted. Results: There was no significant difference in the onset of sensory block .Time from injection to highest sensory block is significantly higher in butorphanol group. 25mcg of intrathecal butorphanol was found to provide a longer duration of two segment regression , longer duration of sensory regression to S2dermatome ,time to reach modified bromage grade 1 and prolonged time for first rescue analgesia as compared to 25mcg intrathecal fentanyl .Time for onset of modified bromage grade 3 is significantly higher in butorphanol group. Conclusions: Both 25mcg fentanyl and 25 mcg butorphanol given intrathecally along with 12.5 mg [ 2.5ml ] of hyperbaric bupivacaine provide effective anaesthesia for lower limb surgeries. Intrathecal bupivacaine-butorphanol mixture provides longer duration of sensory, motor blockade and superior analgesia than intrathecal fentanyl- bupivacaine mixture.