Total Intravenous Anesthesia In Laparoscopic Cholecystectomy: Comparison Of Butorphanol And Fentanyl

摘要

Background: The study aimed to compare the analgesic efficacy and recovery characteristics of fentanyl and butorphanol as analgesic under TIVA (Total Intravenous Anesthesia) for laparoscopic cholecystectomy and find out the better combination along with propofol. Materials and methods: Sixty patients of ASA grade I and II of either sex in the age group of 18-60 years undergoing laparoscopic cholecystectomy were allocated to one of the two groups of 30 each. Group I received inj. fentanyl in the doses of 2 μg/kg while patients in group II received butorphanol in doses of 25μg/kg. All the patients were induced with inj. propofol 2 μg/kg and intubated with 100 μg/kg Vecuronium. Anesthesia was maintained by oxygen and propofol. Intra-operative analgesic efficacy was measured by hemodynamic parameters (HR, MAP). Results and Conclusion: Suppression of sympathetic response to laryngoscopy and intubation was better with butorphanol than fentanyl. The emergence time, recovery time and post operative sedation was less in the fentanyl group (group I) while post operative analgesia was more in the butorphanol group (group II). There was no evidence of nausea and vomiting in any of the two groups. We can conclude that butorphanol provides better analgesia with total intravenous anesthesia as compared to fentanyl. Introduction Laparoscopic cholecystectomy combines the benefit of completely removing the gallbladder with the advantages of shorter hospital stays, more rapid return to normal activities, less pain associated with the small, limited incisions and less postoperative ileus compared with the open laparotomy technique. With the advancement in anesthesiology practice, the hospital stay has reduced. However, the basic requirements for anesthesia have not changed from “analgesia, anesthesia and muscle relaxation” (1).The availability of intravenous sedatives/hypnotics with rapid onset, stable operating conditions, shorter recovery profiles along with newer, more potent analgesics and user friendly infusion delivery systems has facilitated the TIVA technique to a great extent for laparoscopic procedures.Propofol has proven to be suitable as a hypnotic for TIVA technique providing rapid onset as well as rapid recovery of protective reflexes and of cognitive and psychomotor functions. At the same time, it must be administered in combination with drugs fulfilling other components of anesthesia.Out of all modalities available to relieve pain, systemic opioids stand atop. Opioids produce analgesia primarily as a result of their agonist effects on opioid receptors in the CNS. The physico-chemical properties of different opioids can result in difference in their pharmacokinetic, pharmacodynamic and side-effect profiles. Though, there are lots of studies including fentanyl as an adjuvant analgesic under TIVA technique, only very few studies have been done with butorphanol.Butorphanol, a synthetic opioid derivative is a mixed agonist-antagonist with analgesic potency greater than morphine and pethidine(2). Butorphanol and its metabolites are agonist at kappa-receptor (κ) and mixed agonist-antagonist at mu (μ) receptors. Butorphanol is available only in the parenteral form, thus better suited for acute pain relief. Butorphanol unlike morphine exhibits a ceiling effect on respiratory depression(3).The aims and objectives of this study were to compare the analgesic efficacy as well as recovery characteristics of intravenous butorphanol with intravenous fentanyl, as an adjuvant analgesic to TIVA for laparoscopic cholecystectomy. Material & Methods After obtaining approval from hospital ethical committee and informed consent from the patients, sixty patients between the age of 20-60 years belonging to ASA grade I and II scheduled for elective laparoscopic cholecystectomy were studied. The patients were subjected to detailed clinical examination and routine investigations to exclude any associated systemic disorder. Exclusion Criteria: The patients wit