Role of butorphanol in preemptive analgesia: a comparison with pentazocine

Background: Preemptive analgesia establishes effective antinociception before surgery and continuation of this effective analgesic level well into the postoperative period. Butorphanol tartrate and pentazocine lactate are opioid analgesics with mixed agonist-antagonist properties

Aim: The aim of the present study was to compare the preemptive analgesic effect of butorphanol and pentazocine given by intramuscular [IM] route as a primary outcome. Secondary outcome was to compare hemodynamic parameters and the side effects profile

Methodology: A comparative randomized, single blind, and prospective clinical study in sixty patients ASA physical status I and II was carried out. Patients were demographically similar. Patients were randomized to receive either a butorphanol injection [Group B] 2 mg [n=30] or pentazocine injection [Group P] 60 mg [n=30] both IM 60 min before surgery. Lower abdominal surgeries under spinal anesthesia were selected. Duration of pain relief was recorded by visual analogue scale [VAS] postoperatively up to 24 h. Sedation was measured with Cook's sedation score system. Patients were observed for any change in vital signs and any other side effect for 24 h. Rescue analgesia in the form of IM diclofenac sodium 75 mg was given when VAS>3

Results: Duration of analgesia was up to 18 h in Group P while it was extended in Group B, but this was statistically not significant. Requirements of rescue analgesia were higher and occurred earlier in Group P, although not statistically significant. Sedation score was also comparable. Hemodynamic changes were not significant with the exception of an increase in mean arterial pressure in Group P. No severe side effects were observed in any patient of either group

Conclusion: Butorphanol a mixed agonist-antagonist opioid in the dose of 2 mg IM is an acceptable alternative to pentazocine as a pre-emptive analgesic due to longer duration of analgesia and greater analgesic efficacy with low incidence of side effects

comparative study between ropivacaine 30 ml [0.75%] and ropivacaine 30 ml [0.75%] with clonidine 150 microg as an adjuvant in brachial plexus block through supraclavicular approach

Ropivacaine is a novel alternative to bupivacaine with the less cardiovascular system and central nervous system toxicity. Clonidine, an alpha 2 agonist, may have benefited patients when it is injected at peripheral nerve sites with local anesthetic ropivacaine. Clonidine is second only to epinephrine as a useful adjuvant for brachial plexus blockade. A clinical study was carried out to compare the anesthetic effects of ropivacaine alone and clonidine as an adjuvant to ropivacaine in brachial plexus block for upper limb surgeries. A comparative, double-blind, prospective, randomized, clinical study was carried out on 60 patients of either sex of American Society of Anesthesiologist physical status I and II, with age group 25-65 years undergoing various orthopedic surgeries of upper limb under supraclavicular brachial plexus block. Patients were randomly allocated to either of the two groups of 30 each. Group-R: Injection ropivacaine 30 ml [0.75%] with 1 ml normal saline. Group-ropivacaine clonidine [RC]: linjection ropivacaine 30 ml [0.75%] with injection clonidine 1 ml [150 microg]. Heart rate, mean arterial pressure, onset and duration of motor and sensory blockade were observed during preoperative, intraoperative and postoperative period. At the end of the study, the data were analyzed using Chi-square test for qualitative data and Student t-test. P < 0.05 was considered significant and P < 0.01 was considered as highly significant. Demographic and hemodynamic data were comparable. Onset of sensory and motor block was significantly earlier in Group-R. Duration of analgesia and motor blockade was prolonged in the RC group. Both groups were observed for the side-effects, which were not significant. Addition of clonidine 150 microm to ropivacaine 0.75% 30 ml delays the onset of sensory and motor blockade while prolongs the postoperative motor blockade and analgesia significantly without producing any clinical significant side-effects in brachial plexus block through supraclavicular approach