Swathi N, Ashwini N, Shukla Mukesh I
Department of Anaesthesia, Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India.
Department of Anaesthesia, JSS Medical College and Hospital, Mysore, Karnataka, India.
Anesth Essays Res. 2016 Sep-Dec;10(3):462-467. doi: 10.4103/0259-1162.177522.
To compare the efficacy of combination of epidural local anesthetic with tramadol and butorphanol in major abdominal surgeries.
To evaluate duration of analgesia, analgesic efficacy, and safety profile of two groups of drugs-epidural butorphanol with bupivacaine and epidural tramadol with bupivacaine.
A prospective, randomized controlled, double-blinded study was undertaken in 50 patients scheduled for major abdominal surgeries. Group B received epidural butorphanol 2 mg + bupivacaine 0.125% first dose and subsequent doses, butorphanol 1 mg + bupivacaine 0.125% (total volume 10 ml). Group T received epidural tramadol 2 mg/kg + bupivacaine 0.125% first dose and subsequent doses, tramadol 1 mg/kg + bupivacaine 0.125% (total volume 10 ml). Observed parameters were the quality of analgesia, sedation, and hemodynamic parameters in the intra and post-operative period. Time for request of rescue analgesia was noted in all the patients. Continuous data are analyzed by Student's -test using IBM SPSS software version 20. ≤0.05 was considered to be statistically significant. ≤ 0.001 was considered to be statistically highly significant.
Visual analog scale better with butorphanol group than tramadol (0.12 ± 0.332 and 0.84 ± 0.746 for Group B and Group T) at 30 min after first dose. Onset of action (8.44 ± 1.158 min in Group B and 12.80 ± 1.354 min in Group T) faster with butorphanol but duration of analgesia longer with tramadol (5.92 ± 0.76 h in Group B vs. 7.68 ± 0.76 h in Group T). Sedation was seen in patients with butorphanol group. Nausea and vomiting more frequent with tramadol group.
Epidural tramadol with antiemetic is better than butorphanol for its longer duration in ambulatory surgery, elderly patients, obese patients, and suitable high-risk patients.
比较硬膜外局部麻醉药与曲马多和布托啡诺联合使用在腹部大手术中的疗效。
评估两组药物——布托啡诺与布比卡因硬膜外联合用药和曲马多与布比卡因硬膜外联合用药的镇痛持续时间、镇痛效果及安全性。
对50例计划进行腹部大手术的患者进行了一项前瞻性、随机对照、双盲研究。B组首剂给予硬膜外布托啡诺2mg+布比卡因0.125%，后续剂量为布托啡诺1mg+布比卡因0.125%（总量10ml）。T组首剂给予硬膜外曲马多2mg/kg+布比卡因0.125%，后续剂量为曲马多1mg/kg+布比卡因0.125%（总量10ml）。观察指标为术中和术后的镇痛质量、镇静情况及血流动力学参数。记录所有患者要求使用补救性镇痛的时间。使用IBM SPSS软件20版通过学生t检验对连续数据进行分析。P≤0.05被认为具有统计学意义。P≤0.001被认为具有高度统计学意义。
首剂给药后30分钟时，布托啡诺组的视觉模拟评分优于曲马多组（B组为0.12±0.332，T组为0.84±0.746）。布托啡诺的起效时间更快（B组为8.44±1.158分钟，T组为12.80±1.354分钟），但曲马多的镇痛持续时间更长（B组为5.92±0.76小时，T组为7.68±0.76小时）。布托啡诺组患者出现了镇静情况。曲马多组恶心和呕吐更为频繁。
对于门诊手术患者、老年患者、肥胖患者以及合适的高危患者，硬膜外使用曲马多并加用止吐药因其镇痛持续时间更长而优于布托啡诺。
