A comparative study of the effect of Normal saline and butorphanol as adjuvant to intrathecal bupivacaine for postoperative analgesia in total abdominal hysterectomy

Background & Aims: Adequate management of postoperative pain improves recovery and patient satisfaction. Spinal anesthesia with local anesthetics alone provides limited duration of analgesia, and intrathecal adjuvants are often used to prolong pain relief. This study aimed to compare the efficacy of intrathecal butorphanol versus normal saline as an adjuvant to 0.5% hyperbaric bupivacaine in patients undergoing total abdominal hysterectomy. Methods: A prospective, randomized, double-blind study was conducted on 60 ASA I–II female patients aged 30–50 years scheduled for abdominal hysterectomy. Patients were allocated into two groups (n=30 each). Group 1 received 3.5 mL of 0.5% hyperbaric bupivacaine with 0.5 mL normal saline, while Group 2 received 3.5 mL of 0.5% hyperbaric bupivacaine with 250 µg butorphanol (0.25 mL) and 0.25 mL normal saline. Block characteristics, hemodynamic parameters, duration of analgesia, motor block, and adverse effects were recorded. Results: Demographic variables and intraoperative hemodynamic parameters were comparable between groups. The time to two-segment regression (180.02±4.43 vs. 140.9±1.73 min), duration of motor block (240.2±15.1 vs. 184.7±8.5 min), and time to first rescue analgesic (285.3±8.5 vs. 211.3±8.8 min) were significantly prolonged in the butorphanol group (p<0.0001). Incidence of adverse effects such as hypotension, bradycardia, and nausea/vomiting was minimal and comparable between groups, with no incidence of pruritus, respiratory depression, or urinary retention. Conclusion: Intrathecal butorphanol (250 µg) as an adjuvant to hyperbaric bupivacaine significantly prolongs postoperative analgesia and motor block without increasing adverse effects, making it an effective option for patients undergoing total abdominal hysterectomy.