title: Effectiveness of butorphanol as an adjuvant to lidocaine for haematoma or periosteal block: A prospective, randomised, double blind study.
abstract: BACKGROUND
  The peripheral nerve endings carrying pain contains opiod receptors. Blocking these receptors during haematoma block or periosteal block may provide better analgesia.
  
  
  OBJECTIVE
  Evaluation of effectiveness and safety of butorphanol as an adjuvant to lidocaine for haematoma block.
  
  
  METHODS
  This is a two centre, prospective, individually randomised, two group, parallel, double-blind clinical trial.
  
  
  METHODS
  In this study, 115 American society of anaesthesiologist grade I and II adult patients scheduled for closed reduction of fractures were randomly allocated into two groups; Group A received 1% lidocaine (2 mg/kg) where as Group B received 1% lidocaine (2 mg/kg) with butorphanol (0.02 mg/kg) during haematoma block. Pain was assessed before, during and after manipulation of fracture by using visual analogue scale (VAS 0-10). Onset time of block, time for first rescue analgesic, 24 hour analgesic requirement and sedation levels were noted.
  
  
  METHODS
  Data analysed with the unpaired t-test with Welch correction assuming unequal variances and Fisher's exact test using Graph pad Prism 5.02 version.
  
  
  RESULTS
  Onset time of haematoma block was significantly less in the butorphanol group compared to the lidocaine group (P=0.0003). The mean time for first rescue analgesic was significantly higher and total analgesic requirement was significantly lower in the butorphanol group (P<0.0001). Mean VAS scores were lower and sedation scores were higher in the butorphanol group.
  
  
  CONCLUSIONS
  Addition of butorphanol to lidocaine quickens onset of haematoma block, provides excellent post manipulation analgesia and decreases 24 hour total analgesic requirement without excessive sedation.
authors.affiliation: Department of Anaesthesiology and Critical Care, Rajiv Gandhi Institute of Medical Sciences, Putlampalli, Kadapa, India.
authors.forename: Nawaz Ahmed
authors.initials: NA
authors.lastname: Shaik
authors.forename: Surisetty Sreenivasa
authors.initials: SS
authors.lastname: Rao
authors.forename: Sunil
authors.initials: S
authors.lastname: Chiruvella
authors.forename: Manduri Sreenivasa
authors.initials: MS
authors.lastname: Rao
authors.forename: Siddareddigari Velayudha
authors.initials: SV
authors.lastname: Reddy
keywords: Butorphanol; closed fracture reduction; haematoma block; periosteal block