Comparative evaluation of recovery characteristics of fentanyl and butorphanol when used as supplement to propofol anaesthesia (original) (raw)
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OBJECTIVE: The aim of this study was to determine the effects of total intravenous anesthesia with propofol and fentanyl compared with those of isoflurane and fentanyl on recovery characteristics, postoperative nausea and vomiting (PONV) and duration of hospitalization. METHODS: Patients classified as ASA status I or II undergoing elective short surgical procedures, with duration up to one hour were enrolled in the study. Patients were randomly assigned at a 1:1 ratio to receive total intravenous anesthesia with propofol (1.5–2.0 mg/kg) and fentanyl (1.5 μg/kg) or isoflurane (0.8%–1.2%), nitrous oxide and fentanyl (1.5 μg/kg). Extubation time, recovery time, PONV, postoperative antiemetic requirement and duration of hospitalization were recorded. Results: 120 patients completed the study. Recovery time was significantly shorter in the propofol group (n = 60) compared with the isoflurane group (n = 60) (7.0 [0.77] vs 8.5 [0.66] min, respectively; P< 0.005). In the propofol group, significantly fewer patients had vomiting episodes compared with those in the isoflurane group (4 [6.7%] vs 32 [53.3%]; P< 0.005). The duration of hospitalization after surgery was significantly shorter in the propofol group than in the isoflurane group (22.60 [3.6]vs. 25.5 [4.1]hours; P = 0.0001). CONCLUSION: Total intravenous anesthesia with propofol and fentanyl was associated with a significantly reduced rate of PONV , shortened recovery time and duration of hospitalization, compared with isoflurane and fentanyl in these patients undergoing surgery up to one hour .
2017
Introduction: Opioids when combined with propofol not only have a synergistic anaesthetic effect but also they successfully blunt the haemodynamic response to the noxious stimuli during surgery. Current study two opioid analgesics, fentanyl and butorphanol are used in propofol based anaesthesia in the abdominal surgery cases to study their effectiveness in attenuating the haemodynamic response. Material and Methods: Cross-sectional study was undertaken on 60 adult patients admitted for abdominal surgeries. Participants were divided in two equal groups where group 1 received Inj. Fentanyl (2mcg/Kg) and group 2 received Inj. Butorphanol (20mcg/Kg).The hamodynamic variables HR, SBP, DBP and MAP recorded prior to study drug administration i.e. at preoperative (POP), Post study drug administration (POSD), at induction (IND) at laryngoscopy (LYNG), at intubation (INTUB), every 1 minute after intubation and at skin incision (INC). Descriptive analysis was done by summarizing the continuous data in mean and standard deviation. Student t-test was used to study the mean difference between the two study groups. Conclusions: Fentanyl and Butorphanol were effective in controlling HR, SBP, DBP and MAP which are constituents of haemodynamic response to laryngoscopy and intubation. Fentanyl offered better haemodynamic stability with laryngoscopy, intubation and skin incision. Results:After administration of IV Fentanyl and Butorhanol mean HR decreased from 86.83±11.91 to 85.63±11.60 (p<0.05) and 90.97±14.13 to 87.63±13 (p<0.05) respectively. There was statistically significant difference in both the groups in mean SBP at every one minute after intubation upto skin incision (INC). The mean DBP at laryngoscopy between two groups were significant (p=0.006).
International Journal of Research in Medical Sciences, 2016
Background: Levobupivacaine, an S(-) isomer of bupivacaine, has been shown a lower risk of cardiovascular and central nervous system toxicity than bupivacaine. This study was aimed to compare racemic bupivacaine and levobupivacaine in epidural anesthesia for lower limb orthopedic surgeries using fentanyl as a common adjuvant. Methods and Material: A randomized prospective study was planned on sixty patients of ASA grade I and II who were admitted for elective lower limb orthopedic surgeries under epidural anesthesia. Patients were randomly divided into two Groups, Group B (n=30) received bupivacaine 0.5% (13ml) and fentanyl 100 µg, Group L (n=30) received levobupivacaine 0.5% (13ml) and fentanyl 100 µg. In both the Group's onset of sensory and motor block, highest level of sensory block, duration of sensory and motor block, degree of motor block and hemodynamic parameters and complications were assessed perioperatively. Results: Mean duration of onset of sensory block was 9.54±1.03 and 9.85±0.97 min for Group B and Group L respectively and onset of motor block for Group B was 19.48±1.58 min and for Group L was 19.01±1.30 min, which were comparable for both Groups (P >0.05). Mean duration of sensory block was 371.33±13.23 min and 366.17±5.83 min in Group B and L respectively and mean duration of motor block was 273.0±11.0 min and 274.9±18.45 min in Group B and L respectively which were comparable in both Groups, (P > 0.05). The degree of motor block assessed by modified bromage scale was higher in Group B than Group L. Hemodynamic changes and complications having no significant differences between two Groups, (P > 0.05). Conclusion: The combination of levobupivacine and fentanyl is equipotent to bupivacaine and fentanyl in epidural anesthesia. Rather it seems to be a better alternative local anesthetic agent in epidural anesthesia for lower limb orthopedic surgeries.
Butorphanol for Post-Operative Analgesia - A Comparative Clinical Study with Ketorolac
2010
Introduction: Butorphanol, an opioid derivative has been shown to have, in addition to its analgesic properties, several other advantageous effects like antistressor, sedative and anti-shivering action. The efficacy and safety profile of ketorolac, yet another widely used post-operative analgesic is well documented. This study aims to compare the two analgesics. Aims and objectives: This study was conducted to compare the analgesic efficacy and other effects of butorphanol and ketorolac, administered intramuscularly, in post-operative patients who have undergone lower abdominal and pelvic surgeries. Materials and methods: 50 patients undergoing lower abdominal and pelvic surgeries under general or spinal anaesthesia were randomly divided into two Groups (25 each). At a particular level of post-operative pain, the patients Groups I and II were administered intramuscular ketorolac 30mg and butorphanol 2mg respectively. The analgesic effect was studied using Visual Analogue Scale (VAS) and the verbal category scale. Patients were monitored for the sedative action, respiratory status and other vital parameters for 300 minutes and for other adverse reactions over the next twelve hours. Observations: Butorphanol provided better analgesia within the first two hours of administration, while ketorolac was more effective at 4-5 hours. Better sedative action without any significant respiratory depressant effect was demonstrated with butorphanol. There were no clinically significant hemodynamic fluctuations or adverse reactions with butorphanol or ketorolac. Conclusions: Butorphanol provides better early analgesia as compared to ketorolac with a desirable and safe sedative effect in post-operative patients who have undergone lower abdominal and pelvic surgeries.
National Journal of Medical Research, 2016
Background: An ideal premedicant drug is anxiolytic, sedative, amnesic, reduces salivary and respiratory tract secretions, analgesic as well as residual post-operative analgesia. The present study was undertaken to compare the effects of intravenous butorphanol and intravenous fentanyl as a premedicant drug in general anesthesia. Methodology: A comparative study between butorphanol and fentanyl was conducted in 100 patients of either sex at Government Medical College, Surat who belong to ASA physical status I or II, in the age group of 18-65 years. Post-operatively respiratory rate, tidal volume, sedation score, oxygen saturation and assessment of pain score was done in the recovery room. Results: When comparing both the groups the patients in the butorphanol group were found to be more sedated upto 60 minutes postoperatively. The difference between the two was statistically significant (p<0.001). In group F, 82% patients had analgesia for 60-120 minutes while remaining 18% of patients had analgesia for 121-180 minutes. In group F, 44% patients had analgesia for 121-180 minutes while 56% of patients had analgesia for 181-240 minutes. In group F, 82% patients had pain (VAS ≥5) by 30 minutes in the postoperative period whereas none of the patients in Group B had significant pain (VAS ≥5) by 30 minutes. Conclusion: We conclude that Butorphanol 20 µg/kg gives better attenuation of the hemodynamic response, longer duration of postoperative pain relief, without producing excessive sedation and with negligible side effects in comparison with fentanyl 1 µg/kg when given intravenously as premedicant for general anesthesia.
IOSR Journals, 2019
A significant number of patients, undergoing Sevoflurane and or Propofol anaesthesia, may develop shivering and hypoxemia, in the immediate post-operative period. However in majority of patients this is relieved spontaneously after some time in fit and healthy patients - no serious problem is posed. As post-anaesthetic shivering increase metabolic rate, oxygen (O2) demand and carbon-di-oxide (CO2) production, it may become hazardous in compromised patient population. Several physical and pharmacological approaches to treatment and prevention of post-anaesthetic shivering have been studied. Pethidine in a low dose has been found to be the most effective and consistent drug in stopping post-anaesthetic shivering. Confusing reports are found in the literature regarding the role of other opioids e.g. Fentanyl in treating post-anaesthetic shivering. Hence, this prospective, randomized, double blind study was conducted in 90 ASA-I patients undergoing operation under general anaesthesia, lasting not more than 1 hour. The patients were divided into 3 groups, – Group-I received Pethidine, Group-II received Buprenorphine and Group-III received Butorphanol. Identical anaesthetic technique was employed for all the patients, namely induction with propofol and maintaining anaesthesia with sevoflurane upto 3vol% using Mapleson-A circuit for spontaneous ventilation. Ambient temperature of operation theatre (OT) and recovery room and temperature of intravenous (IV) fluid were maintained around 30oC. Heart rate, core temperature, oxygen saturation and end-tidal CO2 (ETCO2) were recorded intra-operatively and post-operatively from time to time. Arterial blood gases of shivered patients were done. After proper statistical analysis of the data obtained following observations were found: 1) No correlation could be established between incidence of shivering and the age or body weight of the patient. 2) Overall incidence of shivering 14.44%. 3) No statistical significant difference was obtained in the change of intra-operative and post-operative heart rate as well as intra-operative and post-operative core body temperature. 4) Median value of post-operative arterial oxygen saturation was 99% in all three groups and median value of post-operative ETCO2 was 35mm of Hg in all three groups. There changes could not present any statistical significance. So hypoxia was not statistically significant.
Background Pain Is 'an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage'. Obligation to manage pain and to relieve the patient's suffering is an important part of a health professional's commitment. This study was undertaken to evaluate and compare the analgesic efficacy, respiratory depressant effects, and incidence of hypoxemia following administration of butorphanol and morphine intravenously in postoperative patients using a patient controlled analgesia (PCA) device and to study the convenience of use and acceptability of PCA pump amongst our patient groups. Methodology Sixty patients undergoing lower abdominal, pelvic and lower limb surgeries were selected for the study. They were divided randomly into two groups of thirty each. Patients were allowed use of PCA device as they awakened from anaesthesia. Analgesic efficacy of the regimen was assessed by using a visual analogue scale. Four-hourly-assessment was done. Patients were monitored for respiratory depression by regular assessment of homodynamic status, respiratory rate and oxygen saturation. Results The demographic profile of the patient in the study is as shown in Table 2. Both groups were well matched for age, sex and weight. Mean VAS scores in both the groups at different times were plotted against time. They are also represented graphically. Mean total pain score in 24 hours mean total drug demanded and mean average pain scores for both the groups and the drug demanded by them are as shown in Table 4 and Table 5. During PCA use the patients were watched for side effects like respiratory depression, nausea, vomiting, pruritus, urinary retention, and sedation scores. Table 6 shows the incidence of various side effects. Conclusion Butorphanol is a definite advancement over the conventional opioids with regard to efficacy in pain relief as well as safety and acceptability. Butorphanol is seven times more potent than morphine; however, at equipotent doses the level of analgesia is comparable with lesser incidence of side effects and complications. The status of PCA as an accepted method of pain relief was confirmed.
Anesthesia: Essays and Researches, 2013
Background: Unrelieved post-operative pain may result in the physical suffering as well as multiple physiological and the psychological consequences, which may adversely affect the peri-operative outcome and contribute to increase the length of stay in hospital. Objectives: We designed this study to evaluate the effect of IV Paracetamol and Dexmedetomidine as multimodal analgesic technique on post-operative analgesia and to reduce the consumption of the systemic opioid and its adverse effects in cases of laparoscopic cholecystectomy. Materials and Methods: Eighty consenting, American society of Anesthesiologist-physical status-I (ASA-PS-I), female patients, aged 19-60 year was randomly assigned to one of the following two groups: Group P (n = 40) received IV 1 g Paracetamol infusion over 10 min pre-operatively and 6 hourly thereafter and Group D (n = 40) received IV Dexmedetomidine 1 μg/kg bolus over 10 min pre-operatively and 0.2-0.4 μg/kg/h thereafter for 24 h. Peri-operative hemodynamic variables, post-operative pain scores, and the need for rescue analgesics were recorded and compared. Results: Profi les of intra-operative hemodynamic changes were similar in both groups in respect to heart rate (HR), diastolic blood pressure, mean arterial pressure except in the systolic blood pressure where Dexmedetomidine signifi cantly reduced it in compare to Paracetamol (P = 0.014). Post-operatively 4 th h and 24 th h changes in mean HR between two groups was a statistically signifi cant (P < 0.05). Visual analog scale scores were signifi cantly lower in the Group P compared with Group D at 8 th , 16 th , and 24 th h (P < 0.001). Sedation score were statistically higher in the Group D compared with the Group P at post-operative 4 th , 8 th , 16 th , and 24 th h (P < 0.006). Conclusion: Adjunctive use of both Paracetamol and Dexmedetomidine infusion reduced opioid use. However, Paracetamol peri-operatively provides adequate analgesia with the less sedation whereas Dexmedetomidine provides analgesia and cooperative sedation.