Efficacy of Post Operative Analgesia with Epidural Tramadol, Fentanyl And Buprenorphine

Abstract

Aim : To compare postoperative analgesia among epidural Tramadol, Fentanyl & Buprenorphine over first 24 hours in terms of onset of analgesia, duration, quality of analgesia, number of doses, haemodynamic parameters, respiratory rate and side effects. Methods And Materials: This study was a prospective comparative randomized study. After ethical committee approval a total of 60 patients undergoing elective lower limb or lower abdominal surgeries : were divided into three groups (Group T, Group F and Group B) of twenty each. All the patients were premedicated with Tab. Alprazolam 0.25 mg at 10pm night before surgery and Tab.Ranitidine 150 mg at 7am on day of surgery . Results. The demographic profile (age wise and weight wise distribution) was comparable in all the three groups. The onset of analgesia was shortest (3.75 ± 0.36 min) in fentanyl group followed by tramadol (7.76 ± 0.65 min) and buprenorphine (13.98 ± 1.46 min) groups which is statistically significant. The duration of analgesia was 232.25 ± 19.15 min in fentanyl group, 434.75 ± 33.61 min in tramadol group and 1094 ± 27.29 min in buprenorphine group which is statistically significant. The number of doses required in fentanyl group are 6.7 ± 0.7, tramadol group are 4.0 ± 0.0 and buprenorphine group are 2.0 ± 0.0. The quality of analgesia which was assessed using VAS score showed that the score was less than 1 in all the groups during 24hrs of study period. The changes in systolic blood pressures recorded at 0, 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 18 and 24 hrs among the three groups were statistically not significant. The increase observed at 6 and 7 hrs in tramadol and fentanyl groups compared with buprenorphine group was statistically significant which can be explained based on shorter duration of action of tramadol and fentanyl leading to wearing of the analgesic effect. Respiratory rate showed no significant changes at 0, 1, 2, 3, 4, 5, 8, 9, 10, 11, 12, 18 and 24 hrs among the three groups statistically. The decrease in respiratory rate in buprenorphine group compared to tramadol and fentanyl groups was statistically significant at 6 and 7 hrs. Conclusion: With advent of newer opioids with fewer side effects, the search for appropriate opioid for epidural administration to provide postoperative pain relief still continues. With the introduction of infusion pump in postoperative ward further research can be directed towards patient controlled analgesia and continuous