European Journal of Molecular & Clinical Medicine

Brachial Plexus block either alone or as a part of an anaesthetic sequence is useful as it provides complete relaxation of muscles of upper extremities. Present study was aimed to study additive effects of butorphanol with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries at a tertiary hospital.
Material and Methods: Present study was single-center, prospective, comparative study in patients aged 18–58 years, of both gender, with body mass index (BMI) <25 kg/m2, of American Society of Anesthesiologists (ASA) physical status I to II, scheduled for elective forearm and hand surgeries, Patients fit for surgery, were randomly allocated into two groups using as Group BB (1 mg of butorphanol) & group B (bupivacaine only).
Results: In present study, general characteristics such as age (year), gender (male/female), ASA (I/II), weight (kg), height (cm) & mean duration of surgery (min) were comparable among both groups & difference was not statistically significant. Time taken for procedure (min) & onset of sensory blockade (min) were comparable in both groups and difference was not statistically significant. Butorphanol when added to levobupivacaine in supraclavicular brachial plexus block had early onset of motor block, improves the quality of block, prolonged the duration of sensory and motor blockade as compared to levobupivacaine alone, and difference was statistically significant.  Prolonged the duration of analgesia and late requirement of rescue analgesia as compared to levobupivacaine alone, and difference was statistically significant.
Conclusion: Butorphanol added with 0.375% levobupivacaine in supraclavicular brachial plexus block for upper limb surgeries provides rapid onset of block, better analgesia, good hemodynamic stability and profound and longer analgesia

Background: Shivering is a physiological response to core hypothermia to increase metabolic heat generation. Prolonged impairment of thermoregulatory autonomic function under anaesthesia, along with cool operating room temperatures and cold infusion fluids, causes shivering.
Methods: This prospective study included 90 individuals who shivered under spinal anaesthesia during abdominal or orthopaedic surgery. On shivering, patients received a 1 mL intravenous bolus dose of 50 mg tramadol, 1 mg butorphanol, or 150 mcg clonidine. All 3 groups were compared for shivering control, time to cessation, recurrence, hemodynamic changes, axillary temperatures, and side effects. Data was processed using statistical methods.
Results: Butorphanol and tramadol decrease shivering better than clonidine. Butorphanol, tramadol, and clonidine totally decreased rigours in 83%, 73%, and 53% of patients, respectively. Clonidine (3.3±0.9 minutes) took longer than butorphanol and tramadol (2.1±1.0 minutes and 1.8 ±0.5 minutes; P 0.001).
Conclusion: Butorphanol controlled shivering with fewer recurrences than tramadol, but both were better than clonidine with an early onset of action. Both opioids reduce rigours better than α-2 agonists.

Background: Pain has already been accepted as the sixth vital sign. Hence, attenuation of pain and alleviation of human suffering is of paramount importance in respect to the service provided by anaesthesiologists, for whom the patients submit a virtual suicidal note in the form of expressed consent. Hence, the importance of the study is self-explanatory.
Objective: The purpose of this study was to clinically evaluate the efficacy of post-operative analgesia with epidural Bupivacaine with Butorphanol, Bupivacaine with Fentanyl and Bupivacaine with Nalbuphine.
Material & Method: 75 patients belonging to ASA Ι and ΙΙ, undergoing lower abdominal surgeries were divided into three groups.
Group A: 0.125% bupivacaine + 2 mg butorphanol.
Group B: 0.125% bupivacaine + 100 mcg. Fentanyl.
Group C: 0.125% bupivacaine + 10 mg Nalbuphine Under all aseptic conditions patients were given epidural block with loss of resistance technique.
Results & Conclusion: Conclusions are drawn from the Study: Opioid analgesics with local anesthetics are extremely safe, effective and reliable method of postoperative pain relief. Fentanyl produces faster onset of analgesia with fewer adverse effects like sedation, pruritus, and nausea and vomiting than butorphanol and nalbuphine when given epidurally along with 0.125% bupivacaine. Butorphanol administered epidurally has advantage of longer duration of analgesia than fentanyl or epidural nalbuphine with side effects like nausea vomiting and sedation.

Background: Total intravenous anaesthesia is technique which uses various drugs in combination, given exclusively by IV route to provide general anaesthesia to the patient. TIVA provides a good surgical plane, rapid induction, smooth the emergence from anaesthesia and rapid recovery. Thus making it a desirable alternative for day care surgeries. Propofol is IV anaesthetic agent, having a pharmacological profile favorable for TIVA. However it is known to cause respiratory depression and dose-dependent hypotension, and due its lack of analgesic properties there is a limitation on its employment. Ketamine known for its hypnotic, analgesic and amnesic properties. Butorphanol seems to provide good analgesia but is associated with adverse effects like cardio depressant action, dizziness and sedation.
Methods: A total of 60 patients who will be undergoing surgeries under TIVA in the age group of 20-60yrs will be taken up for this study. They would be further divided in two groups, Group PK will receive ketamine 1mg/kg 1 min prior to administration of propofol and propofol and group PB will receiving butorphanol 20μg/kg 1min prior to administration of propofol. Propofol will be given at a dose of 1.5ml/kg to both the groups during induction . In both the groups anaesthesia will be maintained with propofol 9mg/kg/hr . Patient will be monitored for various parameters such as non-invasive heamodynamic, respiratory parameters. Incidence of pain on injection Propofol, post-operative sedation, nausea, vomiting will also be looked for.
Results and Conclusion : Expected outcome of this study is that the combination of Propofol-ketamine, offers a better haemodynamic and respiratory stability over propofol- butorphanol combination. Pain on injection will be better attenuated by butorphaol than ketamine.