A COMPARISON OF EFFICACY OF EPIDURAL BUTORPHANOL AND FENTANYL FOR POST-OPERATIVE PAIN ANALGESIA IN LOWER ABDOMINAL AND LOWER LIMB SURGERIES UNDER EPIDURAL ANESTHESIA: A PROSPECTIVE RANDOMIZED DOUBLE-BLINDED STUDY

Objective: Lower doses of epidural opioids can achieve post-operative analgesia for infraumbilical surgeries. A study was conducted to compare the efficacy of epidural butorphanol and fentanyl for post-operative analgesia, onset, duration, and side effects in infraumbilical surgeries. Methods: A study was conducted on 80 adult patients, both male and female, aged between 20 and 60 years, having American Society of Anesthesiologists Physical Status I and II, who were undergoing lower abdominal and lower limb surgeries under epidural anesthesia. The patients were randomly divided into two groups: Group A and Group B. Both groups were given injections of bupivacaine 20 mL of 0.5% epidurally. In the post-operative period, when the patient’s Visual Analog Scale score was more than 4, Group A was administered butorphanol 2 mg followed by top-up doses of 0.5 mg, and Group B was administered fentanyl 50 μg followed by top-up doses of 15 μg, which were diluted to 10 mL in normal saline. Along with cardiorespiratory parameters, the study also noted onset, duration, quality of analgesia, and the number of epidural doses in 24 h. The statistical analysis was done using Student’s t-test and two-tailed Fisher’s exact test or Chi-square (χ2) test, and a significant value of p<0.05 was considered. Results: In comparing the post-operative analgesia between both groups, it was found that Group B had significant early onset of analgesia (2.600±0.4557 vs. 6.087±0.7501), shorter duration of analgesia (200.08±26.257 vs. 366.25±42.829), a higher number of epidural doses administered (3.75±1.171 vs. 2.98±0.733), lower quality of analgesia (2.55±0.504 vs. 3.18±0.636), and a greater incidence of vomiting (30.0% vs. 2.5%) when compared to group A. Conclusion: Superior analgesia with higher sedation can be achieved through epidural butorphanol, while fentanyl has a quicker onset of analgesia but a higher tendency for vomiting. Our conclusion is that both options, fentanyl and epidural butorphanol, are safe and effective for achieving post-operative pain relief.