title: A Comparative Study for Post Operative Analgesia in the Emergency Laparotomies: Thoracic Epidural Ropivacaine with Nalbuphine and Ropivacaine with Butorphanol.
abstract: BACKGROUND
  Adequate postoperative pain therapy for emergency abdominal surgeries is important far beyond the perioperative period because sensitization to painful stimuli can cause postoperative morbidity. A prospective, double-blind, randomized study was carried out to compare the quality of postoperative analgesia and side-effect profile between epidurally administered butorphanol and nalbuphine as an adjuvant to 0.2% ropivacaine.
  
  
  METHODS
  A total of eighty patients, 43 men and 37 women between the age of 18 and 65 years of American Society of Anesthesiologists (ASA) Class I E and II E, who underwent intestinal perforation repair surgery were randomly allocated into two groups ropivacaine with butorphanol (RB) and ropivacaine with nalbuphine (RN), comprising of 40 patients each. Group RB received 0.2% ropivacaine containing 2 mg butorphanol while Group RN received 0.2% ropivacaine containing 10 mg nalbuphine through thoracic epidural catheter. Quality of analgesia, cardiorespiratory parameters, side-effects, and the need of rescue intravenous analgesia were observed.
  
  
  RESULTS
  The demographic profile and ASA Class were comparable between the groups. RN group had good quality of analgesia and stable cardiorespiratory parameters for the initial 6 h of postoperative period, after which they were comparable in both groups. Furthermore, the need of rescue analgesia was higher (20%) in the RB group during the first 6 h. The side-effect profile was comparable with a little higher incidence of nausea in both groups.
  
  
  CONCLUSIONS
  Thoracic epidurally administered ropivacaine with nalbuphine is more effective than ropivacaine with butorphanol for immediate postoperative pain relief in patients undergoing emergency exploratory laparotomy.
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India.
authors.forename: Saravana
authors.initials: S
authors.lastname: Babu
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India.
authors.forename: Bikram Kumar
authors.initials: BK
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesiology and Critical Care Medicine, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India.
authors.forename: Gyanendra Kumar
authors.initials: GK
authors.lastname: Gautam
keywords: Butorphanol; emergency laparotomy; nalbuphine; postoperative analgesia; ropivacaine; thoracic epidural