Comparative study of outcome in epidural bupivacaine with buprenorphine and bupivacaine with fentanyl in lower limb surgeries

Abstract

Pain is a complex subjective experience which has been proved difficult to measure in reproducible way. It is found that operative pain is more severe after surgery and thereafter gradually diminishes over next 24 hours. Providing effective analgesia for patients undergoing major surgery is a daily challenge for most anesthetists. The treatment of acute postoperative pain is a major health care issue. Epidural anesthesia /analgesia is one of the best accepted techniques for lower limb surgeries as it provides good sensory and motor block, decreases adverse physiologic responses to surgery such as autonomic hyperactivity, cardiovascular stress, tissue breakdown, increased metabolic rate, pulmonary dysfunction, and immune system dysfunction. Intraoperatively, sensory and motor blockade, quality and duration of Postoperative analgesia, hemodynamic and respiratory parameters, side effects like nausea, vomiting, respiratory depression, urinary retention. In this observational study an effort was made to study the peri operative analgesic efficacy of Inj. buprenorphine and Inj. fentanyl with 0.5 % Bupivacaine epidurally for lower limb surgeries. There were no significant hemodynamic and respiratory side effects in either of the groups. The postoperative analgesia was definitely of a longer duration with the Buprenorphine group. So it is concluded that epidural Buprenorphine is better in providing prolonged satisfactory postoperative analgesia as compared to Inj. Fentanyl. Regarding the side effects, the incidence of nausea and vomiting was more in buprenorphine as compared to fentanyl group, which could be easily treated with antiemetic’s like Ondansetron. Both buprenorphine and fentanyl along with bupivacaine 0.5% can be given epidurally as a single shot injection for perioperative analgesia obviating the need for epidural catheter.