Comparative assessment of the propofol-butorphanol with propofol-fentanyl combination for different insertion conditions of laryngeal mask airway in orthopedic surgery

INTRODUCTION: Shoulder arthroscopy can be performed under regional blocks or general anesthesia. General anesthesia using laryngeal mask airway (LMA) can be an alternative to regional techniques. Insertion of LMA within the hypopharynx mandates a depth of anesthesia apt enough to relax the jaw and obtund the laryngeal reflexes. Various adjuncts are combined with the induction agent propofol to facilitate improved insertion conditions of LMA and improved pain scores in shoulder surgeries. AIM: The aim of this study was to a comparison of insertion conditions of LMA and postoperative pain scores in shoulder arthroscopies using either intravenous (IV) butorphanol or IV fentanyl in combination with IV propofol. METHODS: A total of 100 patients scheduled for various elective surgical procedures were randomly selected and divided into two groups of 50 each, that is, Group F (propofol and fentanyl) and Group B (propofol and butorphanol). Coinduction was done in Group B with IV butorphanol (30 μg/kg) and in Group F with IV fentanyl (1.5 μg/kg). One minute after coinduction, the induction was achieved with IV propofol 2.5 mg/kg, jaw relaxation was assessed, and LMA was inserted. The postoperative pain scoring was done with visual analog scale (VAS). RESULTS: With the observations made and analyzed, we found that the LMA insertion conditions were significantly better with butorphanol (jaw relaxation [90% vs. 34%; P < 0.0001] and ease of insertion [96% vs. 66%; P = 0.0001]) than fentanyl. Comparison of average VAS score of patients postoperatively during the study showed low VAS score in both groups at 1 h, but Group B showed significantly lower score as compared to Group F. Group F showed a higher mean score of VAS at 2 h and 4 h and signified first analgesic need in the majority. CONCLUSION: The use of propofol-butorphanol combination produces excellent LMA insertion conditions as compared to propofol-fentanyl combination. Lower VAS scores due to analgesic effects of fentanyl and butorphanol contribute to painless shifting of patients undergoing shoulder arthroscopy.