A randomized controlled study between fentanyl and Butorphanol with low dose intrathecal bupivacaine to facilitate early postoperative ambulation in urological procedures.

INTRODUCTION: Opioids are widely used in conjunction with local anesthetics as they permit the use of lower dose of local anesthetics while providing adequate anesthesia and analgesia. It both provides adequate anesthesia as well as lower drug toxicity neuraxial administration of opioids in conjunction with local anesthetics improves the quality of intraoperative analgesia and prolongs the duration of postoperative analgesia. Bupivacaine is the most commonly used drug for subarachnoid block due to its lesser side effects. The present study was conducted to decrease the overall dose of local anesthetics with opioid combination for urological procedure with respect to quality of anesthesia and recovery with patient's satisfaction.

MATERIALS AND METHODS: The study population was randomly allocated by computer generated table into two groups; Group A: 5 mg 0.5% bupivacaine + 25 mcg and Group B: 5 mg 0.5% bupivacaine + 25 mg butorphanol.

RESULTS: Highest level of sensory block was T9 and T8 with the fentanyl group and butorphanol group, respectively. The onset of sensory block was early in fentanyl group than butorphanol group. Duration of both sensory and motor block was significantly higher in butorphanol group. There was no incidence of itching in both groups. There were two patients in fentanyl group and one in butorphanol with hypotension for which injection mephentermine was given. Two patients in fentanyl group complained of nausea and vomiting, for which injection ondansetron was given. One patient complained of pain in fentanyl group for which injection propofol with injection fentanyl was supplemented.

CONCLUSION: Low-dose bupivacaine with butorphanol group was devoid of any side effects in the present study but low dose bupivacaine in addition with fentanyl is superior in terms of early postoperative recovery resulting in early discharge and better outcome in comparison to bupivacaine and butorphanol group, which is beneficial in elderly patients with comorbidity.