COMPARATIVE EVALUATION OF EPIDURAL MORPHINE, BUTORPHANOL & TRAMADOL FOR POST OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL SURGERIES

Dr. Sankaran Chockalingam; Dr. Muthu Vijayasankar

Volume : IX, Issue : I, January - 2020

COMPARATIVE EVALUATION OF EPIDURAL MORPHINE, BUTORPHANOL & TRAMADOL FOR POST OPERATIVE PAIN RELIEF IN LOWER ABDOMINAL SURGERIES

Dr. Sankaran Chockalingam, Dr. Muthu Vijayasankar

Abstract :

Background: Neuraxial blockade is the preferred technique over general anesthesia for most of the lower abdominal surgeries. Effective post opera-tive analgesia can be achieved by epidural anesthesia. Depositing opiods in the epidural space helps in extending the postoperative analgesic duration. We want to evaluate the effectiveness of Morphine, Butorphanol and Tra-madol for the post operative period in combined spinal & epidural anesthe-sia. Study design: This study was double blind randomised controlled study carried out on 75 patients undergoing herniorrhaphy, in three groups of 25 each . The patients were randomly allocated into three groups. Group �M� was taken as Morphine study group, Group �B� as Butorphanol study group and Group �T� as Tramadol study group. L2-L3 interspace was iden-tified and using a 18 gauge combined spinal and epidural needle, epidural space was identified after which a long spinal needle (27G) is inserted into sub arachnoid space, about 0.5% hyperbaric bupivacaine 15mg was inject-ed. Then the epidural catheter is inserted in the usual manner and kept 3 to 4 cms into the epidural space. At the end of surgery in group �M� (morphine group) 50 mcg / kg of morphine in 10ml saline was injected through the epidural catheter. In the Group �B� (butorphanol group) 40 mcg/ kg of bu-torphanol in 10 ml saline was injected through the epidural catheter. In group �T� (tramadol group), 1.5mg / kg of Tramadol in 10 mg saline was injected through the epidural catheter and the catheter was removed in all the three groups. Time of epidural opioid injection was noted. The level of consciousness was assessed every hour and graded according to the seda-tion score. The pain relief is graded as VAPS and was assessed every hour and the total duration of post operative analgesia was taken as the period from the time of giving epidural drugs till the patients first requirement of rescue analgesic. Patients were observed for any side effects like respiratory depression, nausea, vomiting, urinary retention, hypotension, pruritus, headache for 24 hours. Kruskal – Wallis �one way analysis of variance test� was performed to find out the level of significance in the duration of analge-sia, quality of analgesia, sedation between the three study groups. Results: Morphine produces excellent post operative analgesia for a dura-tion of 14-16 hours compared to butorphanol with a duration of 7-9 hours, and tramadol with a duration of 4-6 hours. The onset of action of morphine was delayed by 60-90 minutes while butorphanol and tramadol had an ear-lier onset of pain relief with in 5-10 minutes. There was no correlation be-tween sedation score and quality of analgesia. Morphine in these doses epi-durally does not produce respiratory depression and butorphanol which had ceiling effect does not produce the same while no such respiratory de-pression occurred in tramadol. The incidence of vomiting is high with tra-madol group 40% while 20% 20% each in butorphanol and morphine. Hence routine use of antiemetics is advisable after epidural opioids. The in-cidence of urinary retention is 28% with morphine while no such events oc-curred in other two groups. Conclusion: It has been found out by this study that Morphine epidurally provides excellent long lasting pain relief compared to butrophanol and tramadol. Morphine, the queen of opioids with respect to quality and dura-tion of pain relief cannot be compared with any other opioids. Hence it re-mains the gold standard opioid for pot operative analgesia epidurally.