Study to compare effect of equipotent dose of butorphanol versus fentanyl on intraoperative anaesthesia course and postoperative recovery characteristic in patient undergoing laparoscopic surgery

Shital S. Ahire, Shweta Mhambrey, Sambharana Nayak


Background: The recent trend for control of intraoperative and post-operative pain is towards multimodal analgesia where adequate analgesia is provided using 2 or more analgesic agents, thereby reducing undesirable side effects of each agent and improving the efficacy of each with smaller doses. Analgesic effects of butorphanol and fentanyl have been evaluated extensively for acute and chronic pain for last many years. Many of these studies have shown promising results for intra-operative and post-operative pain. They have also shown to have favourable effects on pressure response caused by laryngoscopy and intubation during general anaesthesia. The present study aimed at comparin the effect of butorphanol versus fentanyl in patients undergoing elective laparoscopic surgery with respect to degree of suppression of sympathetic response to intubation and laryngoscopy, intraoperative hemodynamics, emergence time, recovery time and post-operative sedation, time of post-operative analgesic requirement and complications if any.

Methods: The present study designed was a prospective single blind randomised clinical study. After meeting inclusion criteria 60 patients were selected and divide into two groups each consisting 30. Group B received butorphanol (20 µg/kg, i.v) and group F received fentanyl (1 µg/kg, i.v). Required physical parameters are monitored and baseline values were recorded. During surgery pulse rate, B.P, ETCO2, SpO2, intra-abdominal pressures were recorded. Post-operative patient were shifted to recovery room, and monitored for Ramsay score for sedation and VAS score for pain and recorded if present.

Results: From the results it was found that butorphanol 20 µg/kg i.v. prevents response to endotracheal intubation to a greater extent than fentanyl 1 µg/kg i.v and the difference is highly significant statistically <0.001. Both induction and maintainence dose of propofol, total dose of muscle relaxant, vecuronium used are found to be less with the group B than group F and found statistically very highly significant. The pain, measured by the VAS score and requirement of rescue analgesia after post-operative period was found to be lower in group B compared to group F and also group B showed significant levels of sedation (p=0.000), for first half hour, none of the patients had any episode of desaturation (SpO2 <95%) and did not require any further intervention. Nine patients of group B experienced nausea and 2 vomited, while it was 8 and 2 in group F. So incidences of adverse effects are comparable with both groups. These episodes were subsided after giving injection ondansetron.

Conclusions: It was concluded that butorphanol is an acceptable alternative opioid to fentanyl for use as a component of balanced general anaesthesia at the doses studied, because of its ability to produce prolonged analgesia and amnesia, stable haemodynamic parameters, no postoperative respiratory depression and no prolongation of the recovery room stay.


Balanced anaesthesia, Butorphanol, Fentanyl, Propofol

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