title: Comparative study of epidural bupivacaine with butorphanol and bupivacaine with tramadol for postoperative pain relief in abdominal surgeries.
abstract: BACKGROUND
  To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries.
  
  
  OBJECTIVE
  To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine.
  
  
  METHODS
  A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student'st-test using IBM SPSS software version 20.P≤0.05 was considered to be statistically significant.P≤ 0.001 was considered to be statistically highly significant.
  
  
  RESULTS
  Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group.
  
  
  CONCLUSIONS
  Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients.
authors.affiliation: Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Swathi
authors.affiliation: Department of Anaesthesia, JSS Medical College and Hospital, Mysore, Karnataka, India.
authors.forename: N
authors.initials: N
authors.lastname: Ashwini
authors.affiliation: Department of Anaesthesia, B.J. Medical College, Ahmedabad, Gujarat, India.
authors.forename: Mukesh I
authors.initials: MI
authors.lastname: Shukla
keywords: Butorphanol; epidural; tramadol